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POCKET CYCLOPEDIA 

OF 

NURSING 



THE MACMILLAN COMPANY * 

NEW YORK • BOSTON • CHICAGO • DALLAS 
ATLANTA • SAN FRANCISCO 

MACMILLAN & CO., Limited 

LONDON • BOMBAY • CALCUTTA 
MELBOURNE 

THE MACMILLAN CO. OF CANADA, Lm 

TORONTO 





POCKET CYCLOPEDIA 

OF 

Nursing 



R. J. 


EDITED BY 

SCOTT, M.A., B.C.L., 

* NEW YORK 


M.D 


FELLOW OF THE NEW YORK ACADEMY OF MEDICINE; FELLOW 
OF THE AMERICAN MEDICAL ASSOCIATION 
FORMERLY ATTENDING PHYSICIAN TO THE DEMILT DIS¬ 
PENSARY; FORMERLY ATTENDING PHYSICIAN TO 
THE BELLEVUE DISPENSARY 

EDITOR OF “WITTHAUS’ TEXT-BOOK OF CHEMISTRY”, 

“hughes’ practice of medicine”, “the prac¬ 
titioner’s MEDICAL DICTIONARY”, GOULD AND 
PYLE’S “CYCLOPEDIA OF MEDICINE AND 
SURGERY;” ETC., ETC. 


SECOND EDITION 

REVISED 



NEW YORK 

THE MACMILLAN COMPANY 

1924 


1 


All rights reserved 


“RTsm 

■Ss 

i 

Copyright, 1923, 1924, 

By THE MACMILLAN COMPANY. 


Set up and printed. Published March, 1923. 
Second Edition Revised March, 1924. 



n 








MAR 26 ’24 


Printed in the United States of America by 


J. J. LITTLE AND IVES COMPANY, NEW YORK 

@C 1 A 77 S 579 



CONTRIBUTORS 

Ankeny, Faith, R.N. 

Bailey, Harriet, R.N. 
Children’s Hospital, Boston 
Clapp, Edith J. L., R.N. 

Daly, Ellen C., R.N. 
Degenring, Anna, M.D. 
Gladwin, Mary E., R.N. 
Golden, Rose K., R.N. 
Marshall, Mary E., R.N. 
McKeon, Anna G., R.N. 
Noyes, Ursula C., R.N. 
Reilly, Margaret G., R.N. 
Stiles, Margaret F., R.N. 
Toothaker, Helen M., R.N. 
Ursula, Sister M., R.N. 

















Preface to the Second Edition 


The call for a new edition of this book has pre¬ 
sented an opportunity to correct a few typographical 
and other errors which seem to be incident to first 
editions. At the same time it has enabled us to 
make some necessary additions, and to incorporate 
in some of the articles a few changes required to 
bring them up to date. By the courtesy of Doctor 
H. C. Rutherford Darling and Messrs. J. and A. 
Churchill we are enabled to insert the article on 
Massage by Doctor Royle. 


R. J. E. Scott. 




Preface to the First Edition 


The object of the present work is to provide in 
handy form a small reference volume, which a nurse, 
whether graduate or pupil, whether engaged in gen¬ 
eral or in special work, and whether at home or 
abroad, may have for quick reference on any subject 
connected with the practical side of her profession. 

We take pleasure in presenting a number of orig¬ 
inal contributions, especially written for this work; 
and we herewith tender our heartiest thanks to those 
whose names are mentioned in the List of Contrib¬ 
utors. 

In addition, the following is a list of sources from 
which material has been taken: 

Bailey, Harriet. ‘‘Nursing Mental Diseases.” 

Blumgarten, A. S. “Materia Medica for Nurses.” 

Colp, Ralph, and Keller, Manelva W. “Textbook 
of Surgical Nursing.” 

Harmer, Bertha. “Principles and Practice of Mod¬ 
ern Nursing.” 

Harrison, Eveleen. “Home Nursing.” 

Henderson, Louise. “Practical Nursing.” 

Hill, H. W. “Sanitation for Public Health Nurses.” 

Jamme, Anna C. “Textbook of Nursing Proce¬ 
dures.” 

Kimber, Diana G, and Gray, Carolyn E. “Text¬ 
book of Anatomy and Physiology for Nurses.” 

Proudfit, F. T. “Dietetics for Nurses.” 

Smeeton, Mary A. “Bacteriology for Nurses.” 

Van Biarcom, Carolyn C. “Obstetrical Nursing.” 

By the use of a large number of cross-references, a 
general index has been rendered unnecessary. Catch 
words are placed at the top of each page, the first 


PREFACE 


title indicating the first topic on the left-hand page, 
and the second one the last topic on the right-hand 
page. 

Our aim has been to present material written by 
Nurses and for Nurses. 


R. J. E. Scott 


POCKET CYCLOPEDIA 
OF 

NURSING 







POCKET CYCLOPEDIA 

OF 

NURSING 


A 

ABDOMEN, REGIONS OF 

The abdomen is artificially divided into nine regions, by 
four lines, two of which are drawn vertically, and two 
horizontally. There is no uniformity in the location of 
these lines, but the following may be recommended: The 
upper horizontal line is drawn at the level of the lowest 
point of the costal border; the lower horizontal line is 
drawn at the level of the anterior superior iliac spines; 
the vertical lines are drawn upwards from the center of 
Poupart’s ligaments. The regions thus formed, and their 
contents, are indicated on the following page. 

ABORTION 

Synonyms. —Miscarriage, and Premature Labor. 

The terms abortion and miscarriage refer to the interrup¬ 
tion of pregnancy at any time previous to the attainment of 
viability by the fetus, i.e. before the sixth or six and a half 
months. Thereafter, until full time, the term premature labor 
is used. To the lay mind the word “abortion” suggests a 
criminal element, and the term miscarriage should be used in 
speaking to a patient or her friends. 

A miscarriage is a miniature labor, and the later it occurs 
the more nearly does it resemble a full time labor. In all 
cases there are two stages recognizable—that of dilatation 
and that of expulsion. In late miscarriages and premature 
labors the third stage of separation of the placenta is also 
distinguishable. 



ABORTION 


Tlie Abdominal Viscera Regionally Arranged. 


Richt. 

Middle. 

Left. 

Hypochondriac. 

Liver: portion of. 

Kidney: upper and outer 
part. 

Colon: hepatic flexure 
and part of ascend¬ 
ing colon. 

Epigastric. 

Liver: portion of. 
Pancreas: portion of. 
Spleen: portion of. 
Kidneys: portion of. 
Suprarenal bodies. 
Stomach: portion of. 
Duodenum: portion of. 
Large intestine: trans¬ 
verse colon, variable 
portion. 

Hypochondriac. 

Liver: portion of. 
Spleen: portion of. 
Pancreas: portion of. 
Kidney: portion of. 
Stomach: portion of. 
Colon: splenic flexure 

Lumbar. 

Kidney: portion of. 

Ascending colon and 
portion or whole of 
cecum. 

Small intestine: portion 
of. 

U mbilical. 

Kidneys: portion of, 
with ureters. 

Duodenum: portion of 

Jejunum and ileum. 

Transverse colon: por¬ 
tion of. 

Sigmoid flexure and 
commencement of 
rectum. 

Lumbar. 

Kidney: portion of. 

Small intestine: por¬ 
tion of. 

Descending colon and 
portion of sigmoid 
flexure. 

Inguinal. 

Small intestine: portion 
of. 

Cecum: lower portion, 
occasionally. 

Inguinal canal. 

Hypogastric. 

Small intestine: por¬ 
tion of. 

Sigmoid flexure and 
rectum (portion). 

Cecum: occasionally. 

Ureters: portion of. 

Bladder: in children: 
and if distended, in 
adults. 

Fundus uteri and ap¬ 
pendages. 

Inguinal. 

Small intestine: por¬ 
tion of. 

Sigmoid flexure: por¬ 
tion of. 

Inguinal canal. 


Abortion is said to occur most frequently about the third 
month. This is because the decidua is extremely vascular 
in these early months, and the attachments of the ovum 
are still slender and not fully formed. It is most liable 
to occur at times corresponding to the suppressed menstrual 
periods, owing to the increased congestion and greater 
reflex irritability of the uterus at these times. It is more 
common in multipart than in primiparae, especially in those 
who have had a rapid succession of pregnancies. 

Etiology. —The contractions of the uterus, which lead to 
the premature separation of the ovum and its expulsion, 
may be excited in three ways: (i) By hemorrhage into 
the decidua; (2) by death of the embryo or fetus; (3) 
by conditions acting upon the uterine center in the spinal 
cord. 



















ABORTION 


Predisposing Causes. —These are legion, and it is im¬ 
possible to discuss them individually. A little consideration 
will show that they all lead to one or more of the three 
immediate causes mentioned above. Most of them tend 
either to the destruction of the fetal life, or to hemorrhage, 
by producing a congested decidua or affecting the health 
of the vessel walls. They may be classified as follows:— 

1. Paternal. —Syphilis, and other toxic states. 

2. Maternal .— 

(a) General: 

Toxic states— 

Syphilis, Fevers, 

Tubercle, Lead poisoning, 

Toxemia of pregnancy, Malaria, etc. 

Diseases affecting the circulation— 

Heart disease, Kidney disease, 

Liver disease, Lung disease. 

Ecbolic drugs. Excessive fatigue, or emotion. 

(b) Local: 

All causes of acute and chronic pelvic conges¬ 
tion— 

Malformations of the uterus. 

Displacements, especially retro-displacement. 

Metritis. 

Endometritis. 

Salpingitis. 

Tumors. 

Trauma. 

Sexual excess. 

Criminal induction. 

3. Fetal. —Anything leading to death of the fetus, as dis¬ 
eases or deformities of the fetus, placenta (especially low 
insertion, placenta praevia, and extensive infarction as often 
found in albuminuria), membranes, cord, or liquor amnii 
( e.g. hydramnios). 

The relative frequency of all the predisposing causes of 
abortion is said to be—(x) Endometritis; (2) Retrodisplace- 
ment; (3) Syphilis; (4) Toxemia of pregnancy; (5) Criminal 
induction; (6) Low insertion of the placenta. 

Symptoms and Signs. —These are four in number:— 

(1) Hemorrhage. —This is usually the first to appear. It 
begins as a slight discharge in most cases, and becomes more 
profuse as the abortion proceeds. After the uterus has 
expelled its contents the bleeding ceases. 

(2) Pains. —These are miniature labor pains in typical 
cases—situated in the small of the back and passing round 


ABORTION 


to the front, and being intermittent in character. They begin 
gently and become progressively more severe until the abor¬ 
tion has been accomplished. 

(3) Dilatation of the os uteri usually follows the onset of 
pains, but in some cases the os may be found open on ex> 
amination immediately after the pain has begun. When the 
uterine contents have been entirely expelled the os closes 
again just as after labor. 

(4) Protrusion and Expulsion of the Contents of the 
Uterus .—When this occurs there remains no possibility of 
averting the abortion. Occasionally the ovum remains for 
some time in the cervical canal, the uterine contractions 
being too feeble to expel it completely. 

Diagnosis.—The first point to determine is whether the 
patient is pregnant. This may be done by the history and 
the signs and symptoms of early pregnancy. Abortion is 
then diagnosed by the presence of the above symptoms— 
pain, bleeding, dilatation of the os, and possibly protrusion 
of the ovum. 

Varieties.—Abortions have been arranged in different 
varieties from more than one point of view. From the 
etiological point of view they fall into two groups, Spontane¬ 
ous and Induced, and the latter may be further subdivided 
into Therapeutic and Criminal. From the clinical point of 
view abortions are regarded as Threatened (where it seems 
possible to stop the process by appropriate treatment) and 
Inevitable (where the process cannot be stopped). When the 
abortion proceeds it falls either into the category of Complete 
abortions, if the uterus empties itself entirely, or of Incom¬ 
plete abortions, if portions of the products of gestation are 
retained. A last variety is what is called Missed abortion. 
These may be represented in a scheme as follows:— 


Inevitable 


Abortion 


Spontaneous . 


Threatened. 

^Missed. 


Complete. 

Incomplete. 


Induced . 


Therapeutic. 

Criminal. 


Threatened Abortion may be diagnosed when the symp* 
toms are not severe when the bleeding is not excessive, 
the pains infrequent and not severe. The best rule, indeed! 
is to regard every abortion as threatened until it can be 
definitely shown to be inevitable. 

Inevitable Abortion—Free bleeding and frequent and 
severe pains make it unlikely that the abortion will be 




abortion 


averted, but the only thing which can be definitely regarded 
as proving it to be inevitable is either the escape of the 
liquor amnii, or the protrusion of the ovum through the 
external os indicating a considerable separation of the ovum. 

Complete Abortion. —Where the fetus with its membranes 
and the decidua has been expelled entire, as often happens 
in the first ten weeks, the abortion is Complete, and the signs 
and symptoms promptly subside, while the involution of the 
uterus proceeds just as after labor. Inspection of what has 
come away is the best means of diagnosing a complete abor¬ 
tion. Failing that the diagnosis must rest on the cessation 
of the symptoms, the closure of the os, and the subsequent 
disappearance of all signs of pregnancy. 

Incomplete Abortion is specially common from the tenth 
to the twentieth week owing to the firm attachment of the 
placenta. In these cases the membranes rupture and the 
fetus escapes, but the placenta remains with at least portions 
of the membranes and decidua. The pains frequently cease 
after the fetus is cast off, but the bleeding tends to go on, 
and the os remains patent. If the remaining contents are 
not either expelled spontaneously or removed within a few 
days, they are apt to decompose, and the discharge becomes 
offensive. The patient develops sapremia, and the conditions 
are the same as a puerperal sapremia. 

After the contents are removed the discharge soon ceases, 
and the os closes. 

Missed Abortion. —This term is applied to cases in which 
the symptoms of abortion come on, but subside without any¬ 
thing having been expelled. This may recur once or twice, 
and ultimately after months the contents of the uterus are 
expelled in a state which shows that the fetus died at the 
time of the first onset of symptoms. If this first onset of 
symptoms occurs after the placenta is developed, the fetus 
and placenta are usually in a macerated condition, but some¬ 
times they are dried and mummified. 

In all cases of abortion it is most important to instruct the 
attendant or the patient to keep everything that is passed 
from the vagina. This is rarely done without specific in¬ 
structions, and the diagnosis often hangs upon it. 

Treatment 

Prophylaxis. —This is of the greatest importance. It 
implies not merely the treatment of threatened abortions, 
but also that, when an abortion has taken place, the cause 
should be ascertained and treated, so that a subsequent 
pregnancy may not be similarly interrupted. Displacements 
of the uterus must be rectified, endometritis cured, syphilis 
treated, and so forth. During the next gestation particular 


ABOULIA 


care should be observed, especially at times corresponding to 
suppressed menstrual periods, and all causes of pelvic con 
gestion avoided. 

Treatment of Threatened Abortion resolves itself into 

absolute rest and the administration of sedatives—of which 
by far the most effective is opium in some form. The pa* 
tient should be put to bed at once, and remain there with 
her head low, not seeing any visitors. A hypodermic injec¬ 
tion of morphine may be given to bring the uterus rapidly 
under the influence of the sedative, and smaller doses of 
opium given by the mouth at intervals. Only the lightest 
and most digestible nourishment should be given, and very 
hot drinks should be avoided. If the bowels are loaded, they 
should be gently moved by an oil enema, or some mild laxa¬ 
tive. This treatment should be maintained until the symp¬ 
toms subside, and the patient should remain quietly in bed 
for a week after the bleeding has stopped, or preferably 
until the time that would correspond to the next menstrual 
period has passed. If the cause of the abortion is a retro- 
displacement, it should be rectified. The patient should be 
warned not to indulge in freedom of exercise; and to avoid 
sexual intercourse, as hemorrhage is apt to recur. 

Treatment of Inevitable Abortion. —The active treatment 
of an ordinary case of inevitable abortion is— nil. If it be 
left alone, Nature will complete it without the risks always 
associated with interference. Interference is called for, (i) 
if the hemorrhage is so severe as to endanger the patient’s 
life; (2) if the ovum be actually protruding through the 
os: (3) if slight bleeding has been going on for weeks, 
and the patient is becoming ill; (4) if the abortion has been 
proved to be incomplete by inspection of what was expelled; 
(5) if constitutional symptoms appear, due to loss of blood 
or sapremia. 

Premature Labor. —The treatment of miscarriages in the 
sixth month, and of premature labor, differs in no essential 
from the management of an ordinary labor. 

ABOULIA 

Aboulia is shown by hesitation and indecision. Even 
when a strong stimulus is applied, some real incentive for 
action given, no response takes place. A person may be 
unable to dress because he cannot decide which arm should 
first be put into its sleeve, or whether the stocking should 
be first drawn on to the right or the left foot. The same 
difficulty arises whenever a choice or a decision, however 
trivial or important, has to be made. The power to deter¬ 
mine action (volition) is so lacking or diminished that the 


ACCOMMODATION 

patient is unable to make decision, and it usually lias to be 
made for him by the nurse or some other person. 


ABRASIONS 

$ee Wounds. 

ABSCESS 

An abscess is a circumscribed collection of pus in a 
newly formed cavity. There are the usual signs of an 
inflammation—pain, swelling, redness and heat; if the 
abscess is large, fluctuation may be detected. The treatment 
is surgical; the abscess should be opened, and drained. 
Antiseptic dressings are then applied till the abscess is 
healed. 

Special abscesses are retropharyngeal, peritonsillar, mam¬ 
mary and ischiorectal. 

ACCOMMODATION 

Accommodation is the ability of the eye to adjust itself 
so that it can see objects at varying distances. The theory 
most generally accepted is that the ciliary muscle is the 
active agent in accommodation. When the eye is at rest 
or fixed upon distant objects the suspensory ligament exerts 
a tension upon the lens wljich keeps it flattened, particu¬ 
larly the anterior surface to which it is attached. When 
the eye becomes fixed on near objects, as in reading, 
sewing, etc., the ciliary muscle contracts and draws for¬ 
ward the choroid coat, which in turn releases the tension 
of the suspensory ligament upon the lens, and allows the 
anterior surface to become more convex. The accommo¬ 
dation for near objects is an active condition and is always 
more or less fatiguing. On the contrary, the accommoda¬ 
tion for distant objects is a passive condition, in conse¬ 
quence of which the eye rests for an indefinite time upon 
remote objects without fatigue. 

Common Conditions that Affect Accommodation.—The con¬ 
ditions that affect accommodation are: (i) hypermetropia, 
(2) myopia, (3) presbyopia, and (4) astigmatism. 

Hypermetropia or far-sightedness is a condition in which 
rays of light from near objects do not converge soon enough 
and are brought to a focus behind the retina. This is 
usually caused by a flattened condition of the lens or 
cornea, or an eyeball that is too shallow, and convex lenses 
are used to concentrate and focus the rays more quickly. 

Myopia or near-sightedness is a condition in which rays 
•of light converge too soon, and are brought to a focus before 


ACCOMMODATION 


reaching the retina. This is the opposite of hypermetropia 
and is caused by a cornea or lens that is too convex, or 
an eyeball of too great depth. To remedy this condition 
concave lenses are worn to disperse the rays and prevent 
their being focussed too soon. 

Presbyopia is a defective condition of accommodation in 
which distant objects are seen distinctly, but near objects 
are indistinct. This is a physiological process which affects 
every eye sooner or later, and is not due to disease. It is 
said to be caused by a loss of elasticity of the lens. 



Diagram illustrating rays of light converging in (A) a normal 
eye, (B) a myopic eye, and (C) a hypermetropic eye. 


Astigmatism is the condition in which the curvature of 
the cornea or lens is defective. An excess of curvature in 
the long axis of the cornea, as compared with that of its 
horizontal axis, is the more common defect. Glasses with 
curvatures the opposite of those of the eyes are used to 
correct this defect. 

When hypermetropia, myopia, presbyopia, or astigmatism is 
present, the condition is said to be one of Ametropia. 




ACETIC ACID 


A. C. E. MIXTURE 

See Anesthetics. 

ACETANILID (ANTIFEBRIN) 

Acetanilid is a white crystalline powder formed by the 
action of glacial acetic acid, on aniline, a chemical sub¬ 
stance which is an ingredient of many dyes. It is not 
readily dissolved in water. The dose is i to io grains. 

Compound Acetanilid Powder consists of 7 parts of 
acetanilid, 1 part of caffeine and 2 parts of sodium bicar¬ 
bonate. Dose, 8 grains. 

See Antipyretics. 

ACETIC ACID, DILUTE 

Acetic acid is an organic acid formed by the prolonged 
fermentation of various fruits and vegetables. 

Local Action.—Dilute acetic acid hardens and cools the 
skin; it contracts the mucous membranes; it checks bleed¬ 
ing by contracting the blood vessels. Concentrated solu¬ 
tions when locally applied, cause redness, pain, and the 
formation of a blister with slight destruction of the skin. 

Internal Action.—It increases the flow of saliva, thereby 
lessening thirst; it increases the secietion of gastric juice, 
improves the appetite, and aids digestion; it increases the 
secretions, but it is readily neutralized by the alkaline 
intestinal juices. 

Poisonous Effects 

The symptoms of poisoning by large doses of acetic acid, 
are similar to those caused by the mineral acids, but they 
are rarely fatal. The treatment is the same. 

Chronic Poisoning 

Continued use of acetic acid often causes emaciation, 
loss of weight, and anemia. 

Preparations 

Vinegar (not official).—Vinegar is obtained by prolonged 
fermentation of alcoholic liquors. The best vinegar is 
made from cider, and consists mostly of acetic acid. 

Dilute Acetic Acid.—This is a pure form of vinegar 
which contains 6 per cent, of acetic acid. Dose, half a 
dram to two drams. 

These preparations are used principally to harden the 
skin, to check bleeding, and, by inhalation, to relieve faint¬ 
ing. They are also used to neutralize poisoning from 
alkalies. 


ACETONE 


For Local Use 

Glacial Acetic Acid.—This contains 99 per cent, of acetic 

acid. 

Trichloracetic Acid.—This is a crystalline substance. 

These two latter preparations are used principally to re¬ 
move warts and to cauterize or destroy tissues. 

ACETONE 

Test for Acetone.—Pour 5 c.c. of urine to be tested into 
a test tube, add a crystal of sodium nitroprusside, acidify 
with glacial acetic acid, shake well, and then make alkaline 
with ammonium hydrate. The presence of acetone is indi¬ 
cated by a purple color. 

Acetone Bodies.—Diacetic acid, oxybutyric acid, and ace¬ 
tone develop in diabetes as a result of the breaking down 
of the fats and the lack of certain neutralizing agents found 
chiefly in carbohydrate foods. They are often the pre¬ 
cursors of diabetic coma. 

See Diabetes Mellitus. 

ACETPHENETIDIN (PHENACETIN) 

Acetphenetidin or Phenacetin is a white crystalline powder 
made from coal tar. The dose is five to fifteen grains. 

And see Antipyretics. 

ACIDOSIS 

Acidosis is a form of intoxication due to the retention 
in the body of the acetone bodies. It is found in diabetes 
and other conditions, and usually precedes coma; it is gen¬ 
erally fatal. 

See Acetone Bodies, and Diabetes Mellitus. 

ACIDS, INORGANIC OR MINERAL 

The mineral acids principally used in medicine are hy¬ 
drochloric, sulphuric, nitric, nitrohydrochloric, and phos¬ 
phoric acids. They are used principally to replace acid in 
the stomach when its secretion is diminished. The organic 
acids produce practically the same effects as the inorganic 
acids with only slight individual differences. 

Local Action; Applied to the skin, or mucous mem¬ 
branes, concentrated solutions of acids are very injurious 
to the tissues, and destroy the skin, mucous membranes 
and underlying tissues. 

The tissues become shrunken, hard and brittle, because 
the acids withdraw water from the tissues with which they 
come in contact. 


ACIDS, POISONING BY 


Dilute solutions of the acids usually contract mucous 
membranes. 

Internal Action.—In the mouth: The dilute solutions 
ordinarily used have a characteristic sour taste and relieve 
thirst. They increase the flow of saliva and contract the 
mucous membrane of the mouth. 

In the stomach: The acids aid the digestion of protein 
or albuminous food, since the pepsin acts only in the 

presence of an acid, particularly hydrochloric acid. 

In the intestines: If the acid enters the intestines, it is 
immediately neutralized by the alkaline juices which are 
always present there. Salts are thus formed, and at the 

same time the pylorus of the stomach immediately closes, 

to prevent more acid from entering the intestines. 

The acids are rapidly absorbed into the blood from the 
stomach, in combination with proteins or as salts formed 
with the alkalies of the tissues. They then produce no 
effects, except to make the blood somewhat less alkaline in 
reaction. As a rule, the alkalinity of the blood is not 

greatly influenced by acids. 

Excretion 

The acids are eliminated from the body by the urine, as 
acid salts; the alkalies of the salts being kept back in the 
blood. The urine is therefore more acid in character, and 
often slightly injures the kidneys, when the urine may con¬ 
tain albumin or blood. The patient may also have burning 
pain in the bladder when passing urine. 

Administration 

All the acids should be given before or with meals, well 
diluted, sipped very slowly through a glass tube, so as not 
to injure the teeth. Diarrhea and griping pains in the ab¬ 
domen are symptoms of excessive action. 

ACIDS, POISONING BY 

Acute acid poisoning usually results from an acid taken 
with suicidal intent. The poisonous effects of all the acids 
are the same; except that hydrochloric and nitric acids make 
the tissues yellow and hard, while sulphuric acid turns 
the tissues white in color and then brown. 

Symptoms 

i. Severe burning pain in the mouth, throat and 
stomach. The tissues about the mouth become dry, 
shrunken, white or yellow in color. 


ACONITE 


2 Profuse vomiting. The vomited matter contains blood 
and pieces of mucous membrane. 

3. Profuse diarrhea. The stools contain blood and pieces 
of mucous membrane. 

As a result of the destruction of the mucous membrane 
of the stomach and intestines, the patient suffers from: 

4. Profound collapse (rapid, thready, weak pulse, slow, 
shallow breathing, subnormal temperature). Death usually 
occurs in several hours. 

Frequently, as a result of lessened alkaline salts in the 
blood, there occurs: 

5. Difficult breathing. 

6. Twitchings of the muscles or convulsions. 

Occasionally the fumes of the acid may cause swelling 

of the larynx (edema of the glottis), and the patient may 
then die of asphyxia. 

If the patient recovers, he may suffer from various symp¬ 
toms produced by the narrowing (stenosis) of the esoph¬ 
agus, because of the scar tissue formed by the healing of 
the wound. 

Treatment 

1. Neutralize the acid with an alkali; such as magnesia, 
or magnesium carbonate, sodium bicarbonate, or lime water. 

Sodium bicarbonate should be used cautiously as it may 
form carbon dioxide gas and distend the stomach. 

If these substances cannot be obtained, soap suds may be 
used. Giving plenty of water helps to dilute the acid. The 
jtomach may be washed out, but with great care, as the 
jtomach tube may pass through the injured stomach wall. 

2. Protect the mucous membranes of the esophagus and 
stomach by white of egg, milk, flour and water, etc. 

3. Keep the patient quiet. 

4. The collapse is treated with heart stimulants, such as 
caffeine, strychnine, atropine, etc. 

5. Sodium bicarbonate solutions are given intravenously 
or per rectum, to increase the alkaline salts in the blood. 

ACONITE 

Aconite is obtained from the root of Aconitum napellus. 
The root often resembles horse-radish in appearance. The 
active principle of aconite is the alkaloid, aconitine. 

Appearance of the Patient. —When an average dose of 
aconite is given, the patient’s mouth and throat feel warm, 
and he often complains of slight numbness and tingling of 
the lips, tongue and throat, or even in the extremities. The 


ACONITE 


pulse is slower and somewhat weaker, and the breathing 
is usually slow and shallow. The temperature is lower and 
the patient often feels quite weak. 

Action in the mouth: Aconite has a bitter taste and 
causes a prickling and tingling sensation followed by numb¬ 
ness in the mouth and throat. This effect on the nerve 
endings in the mouth, causes a reflex flow of saliva. Later 
the secretions are checked and the mouth feels dry. 

In the stomach and intestines: In the doses that aconite 
is usually given, it produces no effect. In larger doses, how¬ 
ever, it often causes nausea and vomiting. 

Action after Absorption. On the heart: Aconite makes 
the heart beat slower and weaker, and lessens the blood 
pressure. 

The pulse of aconite is usually slow, weak, soft and 
compressible. 

On the respiration: Moderate doses of aconite increase 
the breathing, but large doses make the breathing slower and 
labored. 

On the nerve endings: When taken internally, or when 
applied locally, aconite makes the sensory nerve endings of 
the skin and mucous membranes more sensitive at first, and 
later paralyzes them. This produces the tingling and prick¬ 
ling sensations, followed by numbness, which are so charac¬ 
teristic of aconite. 

The muscular weakness produced by aconite in large 
doses, is due to its effect on the nerve endings in the muscles. 

On the secretory glands: Aconite increases the secretion 
of sweat and saliva. 

Effect on temperature: It reduces temperature by in¬ 
creasing the elimination of heat. 

Poisonous Effects 

Since aconite is rapidly excreted, only acute aconite poison¬ 
ing occurs, usually from the administration of an overdose. 

Aconite is one of the few poisons which cause death very 
rapidly. If a sufficiently large dose is taken, the patient 
may die immediately, from sudden paralysis of the heart. 
Usually, however, the symptoms appear very rapidly and the 
patient dies in about three or four hours. 

Symptoms. —The first, and diagnostic symptom of aconite 
poisoning is: 

The characteristic tingling and prickling sensation on the 
lips, mouth and throat, and a smarting, tingling feeling of 
the skin of the extremities, soon followed by numbness. 

Later this sensation passes over the entire body. 


ADMINISTRATION OF MEDICINES 


Drug 

Time of 
Administration 

Character and 
Quantity of 
Fluid 

Method of 
Administra¬ 
tion 

Acids: 

Dilute hydrochloric t 
Dilute sulphuric [ 
Dilute nitric, etc. J 

Before or with 
meals. 

In tumblerful of 
water. 

[Sipped through 
j a glass tube or 
[ straw. 

Alkalies: 

Sodium bicarbonate 
Lime water 

Calcium salts, etc. 

For effect in stom¬ 
ach after meals. 

For general ef¬ 
fects before or 
between meals. 

In half wineglass¬ 
ful of milk. 

In glass of water. 


Inorganic Salts: 

Sodium sulphate 
Sodium phosphate 
Potassium sulphate 
Potassium and sodi¬ 
um tartrate (Ro¬ 
chelle salt) 
Magnesium sulphate 
Carlsbad water 
Magnesium citrate 
Seidlitz powder. 

In the morning] 
on an empty > 
stomach 

To lessen edema, 
in wineglassful 
of water. 

For cathartic or 
diuretic effect in 
glass (or more) 
of water. 

Dissolve each 
Seidlitz Pow¬ 
der in J to 5 
glass of water 
and mix the 
two together. 

Potassium bitartrate 

Potassium \ . . . 
Sodium f Acetate 
Potassium \ , 

Sodium / Cltrate 

Iodides 

Nitroglycerin, ni- [ 
trites, etc. J 

After meals. 

[In glassful of 
milk flavored 
j with a little 
j sarsaparilla, 

I wine or cinna- 
i mon water. 

Metallic Salts: 

Mercury] 

Iron [Salts 

Arsenic ) 

Silver 1 used as as- 
Zinc.etc./ tringents 
Bismuth salts 

Barium 

For absorption af¬ 
ter meals. 

For local effect 
between meals. 

In glass of milk. 

In small quan¬ 
tity of milk. 

(Iron prepara¬ 
tions should be 
sipped through 
a glass tube or 
straw. 

[For X Ray pic- 
1 tures, in glass 
] of milk or as 
[ porridge. 

Alkaloid Salts: [ 

Morphine ] 

Atropine 

Strychnine,etc. [salts] 
Quinine j [ 

After meals. 

As bitter, before 
meals. 

As bitter, before 
meals,undiluted. 

In wineglassful of 
water slightly 
flavored. 

In wineglassful 
of sherry wine. 
























ADMINISTRATION OF MEDICINES 


Drug 

Time of 
Administration 

Character and 
Quantity of 
Fluid 

Method of 
Administra¬ 
tion 

Glucosides: 

Digalen 

Strophantin 

Ouabain 

Digitalis Prepara¬ 
tions 

Between meals. . 

In glass of water 
slightly flavored. 


Galenicals: 

Extracts 

Infusions 

Fluid extracts 
Tinctures, etc. 

Bitters , 

Before meals. 

Well diluted in a 
large glass of 
water. 

Undiluted and 
unflavored. 


Hypnotics: 

CMoral 

Trional 

Tetronal r 

Veronal J 

Sulphonal 
Paraldehyde, etc. 

15 minutes be¬ 
fore bed-time. 

1 to 2 hours be¬ 
fore bed-time. 

2 to 3 hours be¬ 
fore bed-time. 

f In glass of warm 
j milk or in beer. 

[ Milk should be 
\ well diluted 
[ with water. 

May be given 
per rectum in 
two ounces of 
boiled starch 
■ solution, in¬ 
jected with a 
glass syringe 
through a 
catheter. 

Coal Tar and Syn¬ 
thetic Drugs: 

Phenacetin 

Acetanilid 

Antipyrin 

Pyramidon 

Salicylates 

Aspirin, etc. 

Between meals.. 

In wineglass of 
wine or milk. 


Oils: 

Olive oil l 

Cod liver oil 

Castor oil J 

1 or 2 hours after 
meals. 

fin wineglassful 
i of brandy, wine 
| or lemon juice 
[ or as emulsion. 




Croton oil 


One or two drops 
dissolved in gly¬ 
cerin, olive oil, 
or butter, or on 
a piece of bread 
or sugar. 

To unconscious 
or insane pa¬ 
tients • 

(Placed on back 
of tongue with 
a spoon. 

Hydrocarbons: 

Liquid petrolatum 
(Mineral oil) 
Liquid vaseline 
Albolene 

Russian mineral oil, 
etc. 


(Add just a little 
peppermint, 
raspberry juice 
or cinnamon 
water to flavor. 



































ADRENALIN 


ADRENALIN 

See Epinephrin. 

AFFUSION 

The affusion, like the douche, is a stream of water directed 
against the body. Unlike the douche, it has little mechanical 
effect and is applied to a larger area of the body. It may 
be a local or general application, the water being poured 
over the part from a pitcher or a pail. 

The Effects of the Affusion .—The usual thermal and cir¬ 
culatory reactions follow according to the temperature used. 

The treatment is used as a therapeutic measure in syn¬ 
cope, collapse, or shock, in asphyxia, in fevers and in 
hypostatic congestion. In private practice it is sometimes 
used instead of the douche. 

It is contraindicated in typhoid fever with complications, 
in hemorrhagic cases, and in patients with a decompensat¬ 
ing heart. 

AFRIDOL 

Afridol is a compound of mercury used to disinfect the 
hands, as a surgical antiseptic, and for various skin dis¬ 
eases. It usually comes in the form of a soap containing 
about 4 per cent, of the drug. 

AFTERBIRTH 

This is the popular name for the placenta, umbilical cord, 
and membranes, expelled from the uterus after the birth 
of the fetus; it is often referred to as the “secundines.’ > 

AFTER-PAINS 

After-pains are painful and intermittent contractions, oc¬ 
curring in the uterus of multiparous women for a few days 
after childbirth. They are due to efforts on the part of 
the uterus to expel portions of blood clots, or membrane; 
they are increased by the stimulation of the breasts in 
suckling, and they are very seldom found in primiparse. 
As a rule relief is afforded by the administration of one 
dram of the camphorated tincture of opium with half a 
dram of the fluid extract of ergot! this may be required 
every two or three hours. When this fails a hypodermic 
of morphine sulphate (Mi to J 4 grain) may be needed. 

AGARICUS AND AGARICIN 

Agaricus is a fungus, the white agaric, or Agaricus albus 
or Boletus laricis, which grows on the European larch tree. 
Its active principle is an acid, agaric acid, or agaricin, 
which is the preparation principally used. 


alcohol 


Agaricin checks the secretion of sweat, by paralyzing the 
nerve endings in the sweat glands which cause secretion. 
The effect, however, is not as marked as that of atropine. 
Secretions of the other secretory glands are not affected by 
agaracin. It often causes nausea and frequent move¬ 
ments of the bowels. It does not affect the heart, respiration 
or pupils. It is used principally to check the night sweats 
of tuberculosis. It should be given about four or five hours 
before the expected sweat. 

Agaricin is best given in pill form about five or six hours 
before retiring, as it is very slowly absorbed; dose i/i 2 
to 1 grain. 

Agaric Acid is a very poisonous substance; dose !/4 to Vi 
of a grain. Overdoses cause vomiting, diarrhea and col¬ 
lapse. 


AGURIN 

See Theobromine. 


See Bismuth. 


AIROL 


ALBUMEN, TEST FOR 

See Urine. 


ALCOHOL 

Alcohol is a colorless fluid which evaporates very quickly. 
It has a pungent odor, and a burning taste. It burns very 
easily with a blue flame, and it is often used for heating 
purposes. 

Alcohol is formed by the growth of the yeast plant, in a 
solution of fruits or vegetables containing sugar. This 
process is called fermentation. Starchy fruits or vegetables 
also produce alcohol on fermentation, because the starch 
is changed to sugar, which is then fermented by the yeast. 
The growth of the yeast plant changes the sugar to alcohol 
and carbon dioxide. 

Appearance of the Patient. —After an ordinary dose of 
any alcoholic liquor the patient usually becomes cheerful, is 
satisfied with himself, his surroundings, and those about 
him. He is perhaps more active and more talkative. The 
face is flushed, the eyes are bright and there is a feeling 
of warmth. The pulse is rapid and bounding and the 
breathing is deeper. 

Action 

Local Action: Applied to the skin, alcohol causes redness 
and itching. It hardens the skin, checks the sweat and 


ALCOHOL 


acts as an antiseptic. Because it evaporates quickly, it 
makes the skin feel cold. 

On mucous membranes: It causes a burning sensation 
and contracts the cells of the mucous membrane. 

Internal Action.—In the mouth: Alcohol has a burning 
taste, it increases the flow of saliva, reddens and contracts 
the lining membrane of the mouth. 

In the stomach: Small quantities of weak alcoholic drinks, 
aid the appetite, increase the secretion of gastric juice, and 
the peristaltic contractions of the stomach. 

In the intestines: Excessive doses may cause mild bowel 
movements; some preparations, such as brandy, check diar¬ 
rhea. 


Action after Absorption 

Alcohol is very rapidly absorbed, usually in about fifteen 
minutes. Most of the alcohol enters the blood through the 
lining membrane of the stomach, but a small part passes 
through the mucous membrane of the intestines. 

After absorption alcohol affects principally the circula¬ 
tion, the respiration, and the brain. 

Action on the Circulation. —The heart beats faster and 
somewhat stronger, causing a rapid bounding pulse with an 
increase in blood pressure. At the same time the skin be¬ 
comes flushed by dilatation of its blood vessels. 

It increases the contractions of the heart muscle and 
lessens the impulses sent from the medulla to slow the 
heart. 

In large doses it lessens the contractions of the heart 
muscle. 

In weakened conditions alcohol may act as a food, sup¬ 
plying the heart with energy and thus increasing its mus¬ 
cular contractions. 

Action on the Respiration: Alcohol makes the breathing 
deeper and more rapid. 

Action on the Nervous System: Alcohol progressively 
lessens the action of the brain. It begins by affecting the 
highest intellectual activities, such as will power, judgment, 
reasoning. It then affects the motor and sensory functions. 
Finally it lessens the action of the entire brain and of the 
medulla as well. 

Effect on Temperature: Alcohol lowers the temperature 
because the dilated blood vessels of the skin make the 
body lose heat. 

Effect on Nutrition: Alcohol has a distinct food value. 
About 90 per cent, of the alcohol absorbed is used up in 
the body. It combines with oxygen and is changed to 
carbon dioxide and water. In this way it provides energy 


ALCOHOL 


for the activity of the body cells. It is able, therefore, to 
take the place of such toods a»s carbohydrates (starches, 
sugars) and fats. 

It is only suitable for temporary use, however, as in 
fevers; because if given for a long time, alcohol injures 
the various organs and tissues of the body. This may 
neutralize any effect it may have as a food. 

Action on the Kidneys: Alcohol slightly increases the 
flow of urine. 

Excretion 

About 90 per cent, of every dose of alcohol given is 
used up in the body. The rest is rapidly eliminated by the 
kidneys, the lungs, and the skin, in the urine, the expired 
air, and the sweat. 


Acute Alcoholism 

Acute alcoholic poisoning results from drinking alcoholic 
liquors to excess. The effects constitute the familiar and far 
too common picture of drunkenness. 

Symptoms. —The effects may be divided into two stages: 
The stage of excitement, in which all the higher functions 
of the brain are lessened, and the stage of stupor when all 
the brain actions are diminished. 

Excitement Stage. —The individual is usually talkative; 
his thoughts flow freely. The speech may be brilliant, but 
it is careless, loud, coarse and incoherent. He usually 
moves about in an undignified manner but his gait soon 
becomes unsteady and staggering. The face is usually 
flushed and the pulse and breathing are rapid. 

When larger quantities are taken, the staggering gait 
becomes very marked, nausea and vomiting occur and the 
patient passes into— 

The Stage of Depression.— The individual now falls into 

a deep sleep from which he can only be awakened with 
great difficulty (stupor). All his sensations are lessened 
and he may not feel pain. His muscles are relaxed; and this 
frequently saves him from a fracture after a severe fall. 
His face is blue, the breathing is slow and snoring in 
character (stertorous) and the pulse is rapid, strong and 
bounding. Frequently there is loss of control of the 
rectum and bladder. 

When awakened he is usually dull and stupid and falls 
limply back with a thud. Finally he passes into a condi¬ 
tion of coma (a deep sleep in which he cannot be aroused) 
and collapse, with a rapid, weak, thready pulse, and dies. 

The effects of overdoses of alcohol vary with different 
individuals. Some become sentimental, others quarrelsome, 


ALCOHOL 


and still others fall asleep and have no excitement stage 
at all. 

Fatal results have occurred from a dose of one pint of 
whiskey. 

Treatment. —i. Wash out the stomach. 

2. Give artificial respiration if the breathing is slow and 
shallow. 

3. Apply cold applications to the head. 

4. Keep the patient warm. 

5. Stimulants, such as strychnine, caffeine or a hot coffee 
enema are usually given. 

Chronic Alcohol Poisoning, “Alcoholism” 

Chronic alcohol poisoning results from habitually taking 
alcoholic liquors, especially distilled liquors, such as whiskey, 
gin, etc., which contain large percentages of alcohol. Rarely, 
the symptoms result from habitually drinking beers or 
wines. 

Delirium Tremens 

This is a special kind of temporary alcoholic insanity, 
which occurs in habitual drinkers, when they receive any 
shock. This may be the result of an injury, hemorrhage, an 
infectious disease, or a surgical operation. The symptoms 
are 'due to the patient being deprived of his usual amount 
of alcohol. 

The most common symptoms are hallucinations of the 
various senses, abnormal fear, tremors of the muscles and 
excitement. 

The patient often sees various animals, such as snakes, 
rats, dogs, etc., before him (hallucinations of . sight) or he 
feels them creeping upon him (hallucinations of touch). 
Often he hears voices and is constantly talking to those 
who seem to be speaking to him. The patient usually has 
twitching of the muscles of the extremities and is afraid of 
everybody about him. 

Delirium tremens may be avoided by giving alcohol regu¬ 
larly to those patients who take it habitually; whenever they 
are subject to any shock, or when they have undergone a 
surgical operation. 

Uses 

Locally, alcohol is used for the following effects: 

1. To harden the skin and prevent bed sores. 

2. As an antiseptic; 50-70 per cent, alcohol is the best 
preparation for such use. 

Internally, alcohol is used in the following conditions: 

1. As a cardiac and respiratory stimulant in cases of 
fainting, shock and collapse. Whiskey and brandy are the 
preparations used for this purpose. 


ALCOHOL 

2. To check a cold after exposure, whiskey or brandy in 
hot water relieves the congestion of the internal organs, by 
widening the vessels of the skin. 

3. In acute infectious diseases, such as typhoid fever, 
septicemia, and pyemia, whiskey may be given as a food, to 
reduce fever, to lessen nervousness and to induce quiet 
and sleep. 

In such cases, the pulse will become slower, the tempera¬ 
ture is lowered, the breathing becomes slower and deeper. 
The delirium and other nervous symptoms are lessened, and 
sleep is induced. The tongue becomes moist and the skin 
perspires more profusely. 

When these effects are produced, alcohol is acting favor¬ 
ably. 

When, however, the pulse becomes rapid, the delirium, 
restlessness, uneasiness, and other nervous symptoms are 
increased, the sleeplessness increases and the tongue and 
the skin remain dry, the alcohol is acting unfavorably, and 
the symptoms should be reported to the physician. 

4. In convalescence it is given as a food and for its 
soothing effect. In poisonous snake bite, alcohol, in the form 
of whiskey or brandy, should be given in very large doses. 

5. Beer, brandy, or whiskey and water, may be given at 
bedtime to produce sleep, especially when the inability to 
sleep is due to mental work or nervous strain. 

6. Brandy occasionaly checks diarrhea. 

7. Dilute alcohol is a very valuable antidote for carbolic 
acid poisoning. 

Tolerance 

Individuals who take alcoholic beverages habitually, can 
take large quantities of such drinks without any of the 
usual poisonous symptoms being produced. This condition 
is known as tolerance for alcohol. To obtain effects in such 
individuals, much larger doses than usual must be given, 
often even more than twice the usual dose. 

Administration 

For local use the preparations of alcohol are used. 

For internal use alcoholic liquors are principally used. 

For temporary use and for immediate effects the distilled 
liquors, such as whiskey or brandy, are used. 

They are best given hot, undiluted. Ordinarily, however, 
brandy or whiskey is best given diluted in a glass of 
vichy or seltzer filled with cracked ice, or with milk and 
egg in the form of a milk punch or egg nogg. 

In collapse brandy and whiskey are frequently given hypo¬ 
dermically. 


ALCOHOL 

For continued use the fermented liquors such as wine or 
beer are used. 


Preparations 

Alcohol. —This contains 95 per cent, of ethyl alcohol by 
volume. It is used for rubbing the skin, to prevent bed 
sores. It is also used for burning purposes in alcohol 
lamps. 

Absolute alcohol contains 99 per cent, of ethyl alcohol. It 
is not ordinarily used, except by pharmacists and in labora¬ 
tories. 

Dilute alcohol contains about 50 per cent, of ethyl alcohol 
by volume and about 41 per cent, by weight. This is the 
best preparation to use for antiseptic use. 

For Internal Use 

Whiskey (Spiritus Frumenti) ; dose half an ounce. This 

contains about 44 to 50 per cent, of ethyl alcohol by weight, 
and about 50 to 56 per cent, by volume. It should be at least 
four years old, because the fresh preparations are too 
injurious to the tissues. 

Brandy or Cognac (Spiritus Vini Gallic!) ; dose half an 
ounce. 

This contains about the same percentage of alcohol as 
whiskey. Brandy should be at least four years old, because 
the fresh preparations are too irritating. Brandy contains 
small quantities of tannin. As a result, it has a tendency 
to contract mucous membranes. It is therefore more sooth¬ 
ing to the stomach and intestines, and has a tendency to 
constipate and check diarrhea. 

Bum; dose half an ounce. Rum contains the same per¬ 
centage of alcohol as whiskey. 

Gin; dose half an ounce. Gin contains about the same 
percentage of alcohol as whiskey. Because of the juniper 
which it contains, gin increases the flow of urine (diuretic). 

Wines 

Wines are fermented liquors, made from grapes. Be¬ 
sides the alcohol, wines contain various acids, such as tar¬ 
taric and tannic acids, and some volatile oils. 

White Wine (Vinum Album) 

White wines contain 7 to 12 per cent, of alcohol. 

Dry wines are those which contain no added sugar. 

Sweet wines are those which contain sugar which has been 
added. 

Sparkling wines are those which are bottled before fer¬ 
mentation is complete. They contain carbon dioxide gas, 
and effervesce. 


ALCOHOL 


Champagne is the most commonly used sparkling white 
wine and contains about io per cent, alcohol. 

Champagne should be given ice cold, in teaspoonful doses. 
It is particularly valuable in cases of nausea and vomiting, 
for example, after an operation. 

Champagne is not so effective when the gas escapes. 
This may be avoided by inserting a special tap in the cork, 
and keeping the bottle ort ice, upside down. 

Red Wine (Vinum Rubrum) 

Red wines are made by fermenting colored grapes with 
the skins. They contain a larger percentage of alcohol than 
the white wines. 

'Dry Red Wines: 

Claret contains about 8 to io per cent, of alcohol. 

Sherry (Vinum Xericum) contains about 15 to 20 per 
cent, of alcohol. 

Port Wine (Vinum Portense) is the strongest red wine, 
and contains about 20 to 40 per cent, of alcohol. 

Sweet Red Wines: The most commonly used sweet red 
wines are burgundy and madeira. They contain from 6 
to 20 per cent, of alcohol. 

Sparkling Red Wines: The most commonly used sparkling 
red wine is sparkling burgundy, which contains about 10 
per cent, of alcohol. 

Uses of Wines 

The wines are not as stimulating as the distilled liquors, 
such as whiskey or brandy. They are better suited, how¬ 
ever, for continued use. They aid digestion when taken 
during meals. Sweet wines, however, are apt to disturb 
digestion. 

The wines contain tannic acid and contract mucous 
membranes (astringent action). I hey are therefore moie 
constipating than the distilled liquors. 

Sparkling wines, such as champagne, are soothing to the 
stomach when given in small doses. They are not as stimu¬ 
lating to the heart. Champagne causes intoxication rapidly, 
in spite of the small quantities of alcohol which it contains. 
When taken in larger quantities it is apt to cause headache, 
pain in the stomach, nausea, hiccough, etc. 

Beers 

Beers are made by fermenting starchy grains. They are 
usually made by fermenting brewed barley malt with hops. 

Ale, porter and stout, are the various kinds of beers that 
are used. They contain about 3 to 10 per cent, of alcohol 
with a large amount of solids, mainly sugar and starches. 


ALCOHOLISM 


Because of the starches and sugar which they contain, 
beers are very nutritious. They occasionally disturb diges¬ 
tion, however. 

Liqueurs are preparations of volatile oils containing al¬ 
cohol. Many of them contain sugars. Kirchwasser is a 
liqueur which contains very small quantities of hydrocyanic 
acid. 


ALCOHOLISM 

See Alcohoj.. 

ALE 

See Alcohol. 

ALKALIES 

An alkali is a substance which belongs to a group of 
chemical substances called bases. Alkalies combine with 
acids to form salts. They dissolve proteins, forming protein 
combinations which act like salts. They also combine with 
fats to form soaps. 

The substances commonly used as alkalies are the salts 
of the following elements: Sodium, Potassium, and Am¬ 
monium. 

Local action: Weak solutions of alkalies make the skin 
feel soft and soapy, by dissolving the superficial epidermis, 
or horny layer of the skin. Concentrated solutions destroy 
the skin and underlying tissues, forming a soft crust, which 
soon falls off, leaving an ulcer. Mucous membranes are 
affected in the same way as the skin. Alkalies and their 
salts readily dissolve mucus. 

Internal Action. —Sodium Bicarbonate is the preparation 
commonly given internally. 

In the mouth: The alkalies have a characteristic alkaline 
taste. 

They dissolve the mucous secretions, redden and soften the 
lining membrane of the mouth and tongue and make the 
mouth feel soapy. 

In the stomach: They neutralize and lessen the forma¬ 
tion of the acid in the stomach by combining with the acid 
to form salts. 

In the intestines: The alkalies enter the intestines as salts 
which have been formed in the stomach. They withdraw 
fluid into the intestines from the blood and tissues, which 
then distends the intestines and causes frequent movements 
of the bowels. They also dissolve the mucus in the in¬ 
testine. 

Action after Absorption. —Some of the salts of various 


ALKALIES 


alkalies or those formed in the stomach are readily absorbed 
into the blood. These salts make the blood more alkaline 
in reaction, and thereby relieve various conditions due to 
diminished alkaline salts in the blood (acidosis). They 
have no selective action on any of the organs of the body. 

Excretion. —The alkalies and their salts are excreted 
mainly by the kidneys, increasing the flow of urine at the 
same time. They lessen the acidity of the urine or make it 
alkaline in reaction. They are also slightly excreted by the 
mucous membranes. 

Poisonous Effects of Alkalies 

Acute poisoning frequently results from some of the 
alkalies when they are taken by mistake. Washing soda, 
lye, or sodium carbonate is commonly used for cleaning 
purposes. It is found in every household, and if carelessly 
left around the house, it is occasionally taken by children, 
producing very serious symptoms. 

Symptoms. —The symptoms usually appear in a few min¬ 
utes after the alkali has been taken. 

1. The tissues about the lips and mouth are destroyed 
and covered with a swollen white crust, and there are 
pieces of bloody moist shreds of tissue around the lips and 
mouth. 

2. Severe abdominal pains. 

3. Profuse vomiting. The vomited matter contains pieces 
of mucous membrane and blood. 

4. Occasionally there is diarrhea, the stools containing 
blood and pieces of mucous membrane. 

5. Collapse (rapid thready pulse, slow shallow breathing, 
cold moist skin, and dilated pupils). 

The patient may die of collapse, or occasionally from a 
perforation of the stomach wall, resulting from the destruc¬ 
tive action of the alkali. 

If the patient recovers from the acute symptoms, the 
scars which form at the areas in the esophagus and 
9tomach where the tissue was destroyed, make these organs 
narrower (stenosis). This condition may necessitate rad¬ 
ical surgical treatment. 

Treatment. —x. Give as an antidote, a dilute vegetable 
acid such as lemon juice, vinegar or dilute acetic acid. 

2. Protect the mucous membrane by egg albumin, oils 
or milk. 

3. The collapse is treated with heart stimulants; such 
as caffeine, strychnine, atropine, digitalis, etc., and the 
patient should be kept warm. 

Do not wash out the stomach, since passing a stomach 
tube may cause a perforation of the stomach. 


ALKALIES 


Uses of the Alkalies 

The alkalies are 'principally used for the following con¬ 
ditions: 

1. To neutralize the acid in the stomach, in hyper¬ 
acidity, a condition where there is too much acid secreted 
in the stomach. It is also given in ulcer of the stomach. 
In this condition pain is due to the excessive amount of 
acid formed in the stomach, which is neutralized by the 
alkalies. In these cases the alkalies are best given about 
a half to one hour after meals, when the stomach contains 
the largest amount of acid. 

2. They are also used to dissolve mucus and other 
secretions. 

3. To increase the alkaline salts in the blood in cases of 
diabetic coma and other similar conditions due to excessive 
formation of acids in the body (acidosis). 

Administration 

To neutralize acids, alkalies should be given after meals, 
only slightly diluted to lessen absorption. 

To increase the alkaline reaction of the blood they should 
be given between meals in large quantities of water to 
increase absorption. 

In cases of coma they may be given intravenously or by 
rectum in the form of a proctoclysis. 

Preparations of the Alkalies 

Sodium Compounds 

Sodium is a metallic element. It is found in nature in 
various forms: 

1. As sodium chloride or salt. 

2. As sodium nitrate. 

3. As borax or sodium borate. 

Preparations 

Sodium Hydroxide (Caustic Soda). This comes in white 
sticks, which readily take up moisture from the air. It is 
occasionally applied as a caustic, to destroy tissue. It 
often causes severe injury to the tissues. 

Solution of Sodium Hydroxide; dose 15 to 60 minims. 

This is a s per cent, solution of sodium hydroxide in 
water. 

Monohydrated Sodium Carbonate; dose 5 to 30 grains. 

Sodium Carbonate (Washing Soda); dose 5 to 30 grains. 

These two preparations are rarely used internally. Ex¬ 
ternally they are used to dissolve mucous and other secre¬ 
tions. They are frequently used to clean glass, china, wood- 


ALKALOIDS 


work, etc. They frequently cause poisonous symptoms when 
taken by mistake. 

Sodium Bicarbonate; dose 5 to 15 grains. 

This is the most commonly used preparation. It is 
applied locally to soothe the skin in burns. Internally it is 
said to neutralize the acid in the stomach, and to relieve 
the pains resulting from excessive acid. It is given in seltzer 
or vichy. It is frequently used to soothe the stomach and 
to lessen vomiting. 


Potassium Compounds 

The salts of potassium act like the sodium compounds 
with the following variations in their effects: 

1. Concentrated solutions, such as potassium hydroxide, 
have a greater destructive action on the skin. They destroy 
the skin and underlying tissues, causing an ulcer when the 
resulting crust falls off. 

2. The salts of potassium when absorbed into the blood, 
slightly weaken and slow the contractions of the heart. 

3. They increase the flow of urine more than the sodium 
compounds. 

The potassium salts are very rarely used as alkalies. 


Preparations 

Potassium Hydroxide (Caustic Potash). This comes in 
white sticks which take up moisture from the air. It is 
used principally as a caustic, to destroy tissues. When this 
is applied locally, the surrounding tissues about the spot 
to be cauterized should be well protected owing to its vio¬ 
lent action. . . 

Solution of Potassium Hydroxide; dose 10 to 30 minims. 

This contains 5 per cent, of potassium hydroxide. 

Potasssium Carbonate; dose 5 to 30 grains. 

Potassium Bicarbonate; dose 5 to 30 grains. 

Potash and Lime (Potassa cum Calce). —This is known 
as Vienna paste, and consists of equal parts of potash and 
quicklime and is used locally as a caustic. 

ALKALOIDS 

An alkaloid is an active principle, found in plant drugs 
or made chemically, which acts like an alkali. (An alkali 
is a chemical substance which combines with acids to form 
salts. It turns red litmus paper blue.) Alkaloids also com¬ 
bine* with acids to form salts, which have the same effects 
as the alkaloids themselves. 

Chemically, alkaloids consist largely of carbon, hydrogen 
and nitrogen; some of them also contain oxygen. 


ALOES 


The alkaloids do not dissolve readily in water, but their 
salts are very soluble and are the preparations principally 
used. 

The alkaloids and their salts form a precipitate when 
tannic acid or potassium permanganate is added to them, 
but this precipitate is not soluble and is therefore not 
absorbed, thus making the alkaloids inactive. For this reason 
tannic acid or potassium permanganate may be used as an 
antidote in cases of poisoning by any of the alkaloids. 

The names of all the alkaloids end in “ine.” 

ALOES 

Aloes is the dried juice of several species of Aloes, a 
plant growing in Barbados, and elsewhere. The active prin¬ 
ciple is aloin. 

Aloes acts principally on the large intestine, causing 
irritation, with dilatation of the blood vessels. This action 
results in peristalsis, causing frequent movements of the 
bowels. Aloes is seldom administered alone, but is usually 
given together with other purgatives. 

Preparations 

Pills of Aloes; dose i to 5 pills. Each pill contains 2 
grains of aloes. 

Pills of Aloes and Iron; dose 1 to 5 pills. Each pill 
contains 2 grains of aloes. 

Pills of Aloes and Mastich (Lady Webster’s dinner pill); 
dose, 1 to 5 pills; each pill contains 2 grains of aloes. 

Pills of Aloes and Myrrh; dose 1 to 5 pills. Each pill 
contains 2 grains of aloes. 

Aloin (active principle); dose 1 to 4 grains. 

Lapactic Pills or Pilulae Laxativae Composite, or A. B. & 
S. pills; dose 2 pills. Each pill contains: Aloin, % grain; 
Extract of Belladonna, 1/8 grain; Strychnine, 1/120 grain; 
Powdered Ipecac, Ms grain. 

Tincture of Aloes; dose one-half to two drams. 

Aloes is also contained in the compound rhubarb pill, com 
pound extract of colocynth, and compound tincture of 
benzoin. 

ALTERATIVES 

Alteratives are drugs whose mode of action is unknown, 
but which improve the nutrition of the tissues, and help to 
absorb diseased tissues, thereby restoring them to their 
normal condition. Most of the drugs so used have other, 
important, actions. The chief alteratives are Iron, Arsenic, 
Phosphorus, Mercury, and the Iodides. 


AMENORRHEA 


ALUMINIUM AND ALUM 

Aluminium is a light metal. The only salt of aluminium 
which is used in medicine is the aluminium and potassium 
sulphate, or alum. 

Uses 

Alum Is used principally as an astringent to contract 
mucous membranes. 

It is used as a gargle in i to 5 per cent, solutions. 

For douches, and as a lotion on the skin and mucous mem¬ 
branes, it is used in to 1 per cent, solutions. 

Large doses of alum are occasionally used to produce 
vomiting. 

Preparations 

Alum; dose 5 to 15 grains. 

This is aluminium and potassium sulphate. Alum is very 
injurious to the teeth, and when given internally, it should 
be given through a glass tube. 

Dried Alum or Burnt Alum (Alumen Exsiccatum).—« 
This is alum which has been dried by heat. It absorbs 
moisture from the air. It is often combined with 1 to 5 
parts of alcohol to harden the skin, and prevent bedsores. 

The other salts of aluminium, such as the aluminium 
acetate and the aluminium chloride are used as antiseptics. 

Solution of Aluminium Acetate (Burrow’s solution).— 
This is used in ^ to 2 per cent, solutions as an antiseptic. 

ALUMNOL 

Alumnol (Alumini Naphtbolsulphonas).— This is used in 
^ to 1 per cent, solutions as a surgical antiseptic, as a 
gargle and for douches. 


ALYPIN 

Alypin is an artificial alkaloid which is used as a local 
anesthetic. It is supposed not to produce poisonous symp¬ 
toms. 

It is used principally as a local anesthetic for eye opera¬ 
tions, and in the urethra and bladder, before passing instru¬ 
ments into these organs. 

In the eye it is used in 1 to 2 per cent, solutions. On 
other mucous membranes, it is used 111 1 to xo per cent, 
solutions. 

Preparation 

Alypin Tablets. Each tablet contains % to 3 grains. 

AMENORRHEA 


See Menstruation. 


AMERICAN HELLEBORE 


AMERICAN HELLEBORE 

See Veratrum Viride. 

AMERICAN WORMSEED 

See Chenopodium. 

AMETROPIA 

See Accommodation. 

AMMONIUM 

Ammonium is a solution of ammonia gas in water. 

Appearance of the Patient 

When ammonia gas is inhaled, it causes redness of the 
conjunctiva of the eye, a profuse flow of tears, a flow of 
mucus from the nose, and sneezing. It also causes severe 
coughing with excessive secretion of mucus from the 
bronchi; the pulse is stronger and faster, and the breath¬ 
ing is deeper and more rapid. These effects appear almost 
immediately, but last for a very short time. 

A weak solution of ammonia makes the skin fed and soft. 
The skin feels slippery, as if it were covered with soap. 

Stronger solutions, if kept in contact with the skin and 

prevented from evaporating, form blisters, often destroying 
the skin. 

When ammonia is absorbed from the lining membrane 
of the stomach, it produces no effects; because it is changed 
at once to urea, one of the constituents of the urine. It 
therefore increases the amount of urea in the urine. 

Ammonia is usually given by inhalation and it produces its 
best effects in this manner; they are not very lasting how¬ 
ever. When given by mouth, the same but more lasting 
effects are produced. The drug is absorbed from the 

stomach in the form of ammonium chloride, which is 

formed by the combination with the hydrochloric acid in the 
stomach. 

Ammonia affects principally the heart and the respiration. 
It makes the heart beat stronger and faster, causing a strong 
and rapid pulse; it makes the breathing more rapid and 
deeper. 

Poisonous Effects 

When a strong solution of ammonia is taken, the fol¬ 
lowing symptoms result almost immediately. 

The patient complains of severe burning pain in the 
mouth, throat and stomach. The lips, mouth, throat, 
esophagus and larynx are inflamed and swollen. Often the 
superficial tissues of these organs are destroyed. The swell- 


AMMONIUM 


ing of the larynx may be so severe as to obstruct the breath, 
ing and the patient may choke to death because he is unabh 
to get air into his lungs. 

In addition to these symptoms, the patient feels nauseated, 
and vomits profusely. The vomited matter contains blood 
and pieces of the mucous membrane of the stomach. 

The continual vomiting and the destruction of the lining 
membrane of the stomach cause the symptoms of collapse: 
pale, cold, moist skin; rapid, weak, thready pulse; slow, 
shallow breathing; finally stupor, coma and death. Death 
may result in a few minutes from asphyxia, or later from 
collapse. 

If the patient recovers, the resulting scars which form in 
the esophagus from the destruction of the tissues, may 
cause stricture (a narrow condition) of the esophagus. 

This may cause starvation from inability to swallow food. 

Treatment 

1. Neutralize the ammonia with dilute acids, that are not 
themselves injurious. Vinegar and lemon juice are the best 
acids to use. 

2. Protect the lining membrane of the esophagus and 
stomach with milk, oils, albumen water and other protecting 
drinks. 

3. The collapse is usually treated with heart stimulants, 
such as caffeine, atropine and strychnine. 

4. Do not keep the patient warm, as heat increases the 
action of ammonia. Apply cold applications to the head and 
give plenty of cold air. 

5. If the patient suffers from asphyxia, incising the 
trachea (tracheotomy) may save the patient’s life. 

6. For the resulting stenosis of the esophagus, bougies 
are passed, or surgical interference may be necessary. 

Uses 

Ammonia is used for the following conditions: 

1. As a heart stimulant for temporary effect, for example, 
in fainting. 

2. In the form of liniments, to relieve pain. 

3. To neutralize the acid of the gastric juice. 

4. To check the formation of gas in the stomach. 

5. To increase the cough and expectoration. 

Preparations 

Strong Ammonia Water. —This contains about 28 per cent, 
of ammonia gas. It is never given internally. It is u-sed 
locally, applied to snake bites and to form a blister to 
withdraw fluid from the deeper tissues. 


AMPUTATIONS 


Ammonia Water; dose io to 30 mimims. This contains 
10 per cent, of ammonia gas. 

Aromatic Spirit of Ammonia; dose one half to one dram. 

This contains ammonia water and 4 >per cent, of am¬ 
monium carbonate, together with the oil of nutmeg, oil of 
lemon and oil of lavender. It is used principally to over¬ 
come fainting, as a carminative, and to relieve nausea. 

Solution of Ammonium Acetate (Spirit of Mindererus); 
dose 1 to 4 drams. 

This is used principally to increase sweating (diaphoretic) 
and to increase the flow of urine (diuretic). 

Tor Local Use 

Ammonia Liniment.- —This is a z l A per cent, solution of 
ammonia in alcohol and cottonseed oil. 

Ammonium Carbonate; dose 5 to 10 grains. 

This is used as a heart stimulant and as an expectorant. 

Ammonium Chloride is an alkaline salt formed by the 
combination of ammonia and hydrochloric acid. 

It is used principally to increase the cough and expec¬ 
toration. Dose 5 to 15 grains. 

Poisonous doses cause the following symptoms: 

1. Nausea and vomiting. 

2. Bleeding from the mucous membranes. 

3. Collapse. 

AMPUTATIONS 

Ante-operative Treatment. —The area, through which the 
amputation is to be done and the skin for a considerable 
distance above and below, should be shaved and cleansed 
very carefully. If there are any open sinuses they should 
be protected by packing and sterile dressings, so that their 
discharge will not contaminate the wound. 

To prevent hemorrhage during amputation there are 
several methods devised which aim to compress the blood 
vessels supplying the limb in question. 

Esmarch’ s Method. —This method attempts to squeeze all 
the blood out of the limb by applying an elastic bandage 
which is wound spirally from below upward, well above the 
region of amputation. At the upper limit, an ordinary 
rubber tubing tourniquet is applied and fastened. The 
elastic bandage is then removed. This is not applicable in 
septic conditions, nor in cases of tumor. 

Lister’s Method. —Here the limb is elevated for a few 
minutes and the ordinary tubing applied in a horizontal 
fashion as a simple tourniquet. 

Tourniquets. —These should always be applied well above 
the region to be amputated, and should be sterilized. When 


AMPUTATIONS 


the amputation is to be done near the hip or the shoulder, 
strips of sterile bandage should be applied around the 
tourniquets. These are held firmly by an assistant to 
prevent the tourniquet from slipping. Some surgeons prefer 
to use Wyeth’s pins, elongated steel pins which are pierced 
through the muscles, and the tourniquet in pressing against 
these is prevented from sliding off. 

Amputation Operation.— The technique of the operation is 
variable. Some surgeons will inject all nerve trunks with 
novocaine before cutting them. The bone stump is treated 
in various manners so that a full armamentarium of bone 
instruments should always be on hand. Amputation wounds 
are usually drained. The dressings applied should be large 
and pressure should be evenly exerted either by adhesive 



Method of applying Wyeth’s pins. A, Wyeth’s pins; B, 
tourniquet. 

(From Colp and Keller’s Textbook of Surgical Nursing) 

strips or bandage. As a rule the stump should be elevated. 
Sometimes a small splint is applied to the stump to im¬ 
mobilize it in a more efficient manner. 

After-Treatment. —These patients are apt to suffer from 
considerable shock so not only must this condition be 
watched for, but also the danger of secondary hemorrhage. 
It should be routine practice to have an emergency tour¬ 
niquet set very near the patient’s bed so that should bleed¬ 
ing occur no time may be lost in arresting the hemorrhage. 
If the oozing is marked, the dressing may be reinforced 
or changed in twenty-four hours, although it is better to 
wait forty-eight hours. 

Occasionally when the wound has almost healed it is 
necessary to apply pressure to certain flaps or skin areas to 
relieve tension. This pressure can be obtained by thin ban¬ 
daging or by adhesive strappings. In bandaging, it is always 
to be remembered that the turns which pass over the stump 



AMYL NITRITE 


should be begun from above downward and on the side where 
the longer flap is. Sometimes when the flaps have been cut 
too short, it may be necessary to apply traction to pull the 
muscles over the stump. 

While the stage of healing is in progress, gentle massage 
to the muscle groups will do much to maintain their tone 
and health. 

If the amputation is one of the lower extremity, the 
patient should be taught carefully the proper use of crutches. 
Crutches should not press into the axilla but the weight 
of the body should be sustained by the hand resting on 
the cross piece of the crutch. Special instructions should 
be given as to how to descend and ascend a pair of stairs, 
cautioning the patient to hold the banister with one hand 
and using the other hand to hold the supporting crutch. 
To prevent the crutches from slipping they should always 
be equipped with rubber tips. 

AMYL NITRITE 

See Nitrites. 

AMYLENE CHLORAL 

See Dormiol. 

AMYLENE HYDRATE 

Amylene hydrate is a colorless liquid, having an odor re¬ 
sembling that of camphor, and a pungent taste. It pro¬ 
duces sleep; its effects are similar to those of chloral, but 
they are not as marked. It weakens the contractions of 
the heart and lessens all muscular contractions. 

It is best given in capsules or in water, flavored with 
licorice. Dose, 30 to 60 mimims. 

ANAPHALAXIS (SERUM SICKNESS) 

In some individuals the injection of a serum causes some 
or all of the following symptoms: Fever; headache; 

urticaria (hives); edema of various parts of the body; 
attacks of asthma; collapse. 

These symptoms are due to the injection into the tissues 
of a fluid that contains proteins of bacteria, animals or 
plants. When such proteins are taken as food anaphalaxis 
may not occur. 

The symptoms may be avoided by finding whether the 
patient has been subject to attacks of asthma or hives, or 
whether previous injections of a serum have caused these 
symptoms. 

(And See Serums.) 


ANEMIA 


ANEMIA 

Anemia means the loss or destruction of red blood cells, 
of hemoglobin (the oxygen carriers), or of both. Every 
cell in the body suffers and smothers for the want of 
oxygen, so necessary for all the processes of metabolism. 
The result is muscular weakness, breathlessness and impaired 
function of every tissue and organ in the body. In per¬ 
nicious anemia the marked cell destruction is shown in the 
greatly reduced red cell count and hemoglobin, the peculiar 
lemon color of the skin and fever. The patient becomes 
very weak and suffers from dyspnea, faintness, dizziness, 
palpitation and dyspepsia. 

The effect on the digestive system is seen in the lessened 
hydrochloric acid in the stomach, loss of appetite, vomiting, 
diarrhea or constipation, abdominal pains, discomfort and 
distention. The patient suffers periodically from soreness 
or rawness, sometimes with ulcers of the tongue and 
mouth which may extend to the throat. This causes pain 
in chewing and eating, especially hot, acid, or spiced 
food. 

The Nursing Care consists in providing absolute rest and 
freedom from all conditions, mental or physical, which in¬ 
crease the strain on the heart and other organs. Fresh 
air, sunlight, quiet but cheerful surroundings, freedom from 
care or worry, and plenty of sleep are essential. Every 
atom of strength should be conserved. Anemic patients feel 
the cold and should be protected not only for comfort, but 
to save energy otherwise used in keeping warm. Proper 
bathing, the care of the mouth, the regulation of the 
bowels and of the diet are extremely important. Every 
effort should be made to improve the appetite and to build 
up the strength by a nutritious diet. It should be plain, 
easily assimilated and contain foods rich in iron, such as 
eggs, spinach, fish and meats, etc. Extreme care should be 
taken during the periodic attacks of soreness and rawness 
of the mouth and impaired digestion; good digestion alter¬ 
nates with periods of bad. 

The drugs used in anemia are iron and arsenic. Iron is 
used to aid the formation of hemoglobin. When iron is 
given watch for an upset stomach and constipation. Arsenic 
is given to stimulate the bone marrow in the formation of 
red blood cells. When arsenic is given note if the eyes 
become puffy or if the patient complains of stomach trouble 
or a cold in the head. These symptoms indicate poisoning. 

Transfusions may be given to increase the volume of the 
blood, the number of red cells and hemoglobin, to increase 
the patient’s resistance, and to stimulate the bone marrow. 


ANESTHESIA 


These treatments do not cure the disease but may prolong 
life for a number of years. 

ANESTHESIA 

See Anesthetics; and Labor, Management of. 

ANESTHESIN 

Anesthesin is a chemical substance used as a local anes¬ 
thetic. 

The effects of anesthesin are similar to those of cocaine. 
It produces local anesthesia, but no general effects, as it 
does not dissolve readily and is not absorbed. 

It is used internally to relieve the pain of ulcers in the 
stomach or of cancer of the stomach. It is also applied to 
relieve pain on the mucous membrane of the nose, throat, 
urethra, etc., and on wounded surfaces. 

Preparations 

Anesthesin; dose 5 to 8 grains. 

It is also used in the form of a powder or an ointment. 

Cycloform; dose 1V2 to 3 grains. 

It produces the same effects as anesthesin, but is somewhat 
antiseptic. 

Propesin; dose 4 to 8 grains. 

This acts like anesthesin and it also contracts the mucous 
membrane. It is often used in 1 to 20 per cent, ointments. 

And See Cocaine. 


ANESTHETICS 

Anesthetics are drugs used to produce insensibility to 
pain, so as to enable a surgical operation to be performed 
painlessly. The anesthetics are divided into two groups: 

1. General anesthetics are drugs which produce insensi¬ 
bility to pain and a loss of all sensations throughout the 
body. No sensory impulses are then received by the brain, 
and the patient becomes unconscious and falls asleep. The 
effects of the general anesthetics result from their circula¬ 
tion in the blood. 

2. Local anesthetics are drugs which abolish sensations 
only on the particular area of the body where they are 
applied. Since they do not abolish all sensory impulses, they 
do not produce unconsciousness. 

ETHER 

Ether is a colorless liquid formed by the combination of 
sulphuric acid and alcohol. It evaporates very easily, is very 


ANESTHETICS 


inflammable and has a very disagreeable odor and a burning 
taste. 


Appearance of the Patient 
Ether Anesthesia 

Symptoms of the First Stage of Anesthesia. —The patient 
has probably undergone various preparations for the opera¬ 
tion, and has pictured in his mind various ideas of pain 
and suffering that the operation might produce. This makes 
him quite nervous and anxious, and the pulse quite rapid. 
He therefore regards every act of the doctor or nurse with 
suspicion. When the mask is applied to the face, the 
difficulty of obtaining air causes a choking sensation, and 
the inhalation of the ether causes a burning pain in the 
throat, which often makes him cough and causes a profuse 
flow of saliva. Soon there is a feeling of warmth all over 
the body and the sensations become dulled. The sense 
of touch is blunted, objects are seen through a mist, and 
sounds appear to be at a distance. Often ringing, hissing 
or roaring sounds are heard. The muscles become stiff and 
the arms are held rigid. The face is flushed, the pupils 
are dilated, but they react to light. The pulse is rapid, 
and the breathing is rapid and irregular on account of the 
coughing and choking sensation. These effects last for about 
five or ten minutes and are soon followed by— 

The Second Stage or Excitement Stage. —This stage be¬ 
gins with movements of the arms. The patient tries to 
push the mask away, and attempts to get up. Many patients 
struggle violently, others shout, sing, groan, or burst into 
fits of laughter. 

The pulse during this stage is rapid, the skin is flushed, 

often blue, the breathing is irregular because of the strug¬ 
gling. These symptoms last for a few minutes, the struggling 
then becomes lessened, the shouting and talking become 
indistinct, the breathing becomes very shallow and the 
patient passes into— 

The Third Stage, or the Stage of Anesthesia.—The pa- 
tient now becomes calm, quiet and unconscious. All sen¬ 
sibility is gone. The muscles are relaxed and the re¬ 
flexes disappear, so that when the skin is touched or incised, 
no response or movement is produced. Thus, touching the 
throat does not cause vomiting. The winking of the eye¬ 
lids which occurs when the eye is touched, often remains 
for some time, however. 

The pulse still remains rapid and strong, though it is 
slower than during the first and second stages. The breath¬ 
ing is deep and rapid and is often snoring in character. 


ANESTHETICS 


The pupil is usually contracted, and reacts to light and 
accommodation. 

This stage of anesthesia may be kept up for hours by 
judiciously pouring small quantities of ether on the mask. 

When the ether is stopped, the patient may again become 
somewhat excited and talkative, he feels nauseated and 
vomits. He then slowly regains consciousness, often remain¬ 
ing asleep for a few hours before consciousness is regained, 
and complains of headache and dizziness for hours after¬ 
ward. 


Excretion 

Ether is very rapidly eliminated from the body, by the 
expired air of the lungs, usually in about a half hour. 
When given as an anesthetic, it is entirely excreted in 
about 24 hours; the breath has its unpleasant odor during 
that time. 


Idiosyncrasies 

The most common variations in the effects of ether are 
the following: 

1. In some individuals, and in children, there may be no 
excitement stage. 

2. Patients who have been used to taking alcoholic 
liquors regularly, require large quantities of ether to produce 
anesthesia. These patients usually struggle a great deal. 

3. In some individuals, very small quantities may cause 
poisonous effects. 

Poisonous Effects or “Ether Collapse” 

Acute ether poisoning or ether collapse, usually results 
when too much ether is given to produce anesthesia. 

Symptoms. —1. The first symptom which indicates that 
too much ether is being administered, is slow, shallow and 
gasping breathing. 

2. The face then becomes blue and cyanotic and the 
breathing stops. 

3. The pulse may not become affected, but it soon be¬ 
comes weak and irregular. 

4. The pupils are widely dilated, and do not react to 
light. The pulse gradually grows weaker, and death finally 
results from respiratory paralysis. 

Treatment. — 1. Stop anesthesia; take the mask away. 

2. Give artificial respiration. 

3. Elevate the foot of the table. 

4. Stretch the sphincter of the rectum to induce breath¬ 
ing by the reflex action thus produced. 


ANESTHETICS 

5. Give heart and respiratory stimulants such as caffeine, 
strychnine, atropine, etc. 

Usually, if the collapse is recognized early, these measures 
will revive the patient. 

Dangers of Ether Anesthesia 

The following symptoms occurring during anesthesia often 
warn the anesthetist of impending trouble: 

1. Slow, shallow breathing. 

2. Dilated pupils which do not react to light. 

3. Slow, weak, irregular pulse. 

4. Often the relaxed muscles of the tongue cause the 
tongue to fall back and obstruct the breathing. 

5. In some cases, continued vomiting of the contents of 
the stomach and intestines, during deep anesthesia, may 
cause food particles to enter the lungs and cause asphyxia. 
This can be avoided by constantly keeping the mouth 
thoroughly mopped out. 

Dangers Following Anesthesia 

The most common condition that may occur after ether 
anesthesia is pneumonia. This may result from the injurious 
effect of ether on the lungs. 

Preparations for Anesthesia 

Before administering ether, the following measures should 
always be carried out, but the nurse must receive these 
orders from the surgeon. 

1. Move the bowels by a cathartic, about twelve hours 
before the operation, and give an enema the morning of the 
day the patient is to be operated upon. 

2. Do not give any food or drink for about twelve hours 
before the operation. This often lessens the vomiting after 
the anesthesia. 

3. Catheterize the patient before the operation. 

4. Remove all false teeth, so that the patient will not 
swallow them during the anesthesia. 

5. When the anesthesia is begun, the eyes should be 
covered with a piece of gauze, and the face protected with 
vaseline to avoid the injurious effects of the ether fumes. 

Administration 

To produce anesthesia, ether is given by inhalation through 
a mask held over the nose and mouth, in the following ways: 

The Open Method or Drop Method 

The ether is poured drop by drop on a mask covered with 
gauze, and the patient is then allowed to inhale the ether 


ANESTHETICS 


vapor which is thoroughly mixed with air. This is the most 
common method of administration now in use. 

The Closed Mask Method 

This method is gradually being abandoned. The ether is 
given through a cone saturated with ether, which is thus 
mixed with very little air. 

Gas-Ether Method 

This is a very common method now in vogue, whereby 
the patient is first given nitrous oxide gas, and then ether. 
In this way, many of the unpleasant effects of ether, and the 
excitement stage, are avoided. 

There are numerous kinds of apparatus for giving ethei 
by this method, many of which have various advantages, 
such as warming the vapor, etc. 

In giving an anesthetic, it is important that the drug be 
administered very slowly. The breathing and pulse should 
be watched very carefully throughout the anesthesia, so as 
to avoid serious dangers. 

Uses 

Besides its use as an anesthetic, ether is used for the fol¬ 
lowing effects: 

1. As a heart stimulant. 

2. To check convulsions. 

3. As a carminative, to lessen the formation of gas in the 
stomach and intestines. 


Preparations 

Ether; dose 8 to 15 minims. This contains 96 per cent, 
of ether, and is used principally as an anesthetic. The dose 
of ether for anesthesia varies with the patient, and the 
degree of anesthesia desired. 

Spirit of Ether; dose one-half to one dram. 

This consists of 32 parts of ether and 68 parts of alcohol. 

Compound Spirit of Ether (Hoffman’s Anodyne); dose 
one-half to one dram. 

This contains 32 per cent, of ether, alcohol and other 
substances known as ethereal oils. It is used principally 
to check the formation of gas in the stomach and intestines, 
and as a remedy for fainting. It is usually diluted with cold 
or iced water. 

Spirit of Nitrous Ether (Sweet Spirit of Niter) ; dose 

fifteen to sixty minims. 

This preparation is used to increase the perspiration and 
the flow of urine, but it also causes the same stimulating 
effects as ether. 


ANESTHETICS 


CHLOROFORM 

Chloroform is a colorless non-inflammable fluid, which 
evaporates easily, but not as rapidly as ether. It is used 
principally as an anesthetic. 

Chloroform Anesthesia 

When chloroform is given as an anesthetic, the symptoms 
it produces can be divided into three stages, as in ether 
anesthesia. 

During the first stage, the patient is nervous, anxious, 
and his sensations are dulled, but the anesthetic is Inorr 
pleasant to take than ether. The pulse is usually rapid. 

Very soon, the second stage sets in, the excitement, 
talkativeness and struggling, however, are usually much less, 
and last for a shorter time than with ether. This stage 
is very often entirely absent. 

The stage of anesthesia, or third stage, comes on very 
rapidly with chloroform. The patient is calm, quiet and 
unconscious. The breathing is slow and shallow, the rate of 
the pulse is normal, perhaps somewhat slower but weak. 
The face is pale, and the pupils are contracted, but they 
react to light. All sensibility and reflex action are gone, 
and the muscles are relaxed. 

With chloroform, anesthesia is induced more rapidly than 
with ether, usually in about five or ten minutes. The 
muscles become relaxed sooner, the pulse is weak and 
slower and the breathing is shallow. 

Excretion 

Chloroform is rapidly eliminated, mainly by the expired 
air of the lungs; though some of it is also excreted by the 
urine and the perspiration. 

Poisonous Effects 

Chloroform poisoning occurs in two forms: 

1. Acute Chloroform Poisoning 

Acute chloroform poisoning usually results when too much 
chloroform is given as an anesthetic, or in susceptible in¬ 
dividuals, from very small quantities, even from a few drops. 

Sudden Chloroform Death 

Sudden death occasionally occurs from chloroform, in 
susceptible individuals, even when only a few drops are 
administered for anesthesia. 

This usually occurs during the first stage of anesthesia. 

The pulse becomes very slow and weak, the’ face turns pale, 


ANESTHETICS 


the breathing becomes very shallow and slow, the pupils 
are widely dilated, and the patient dies in a few minutes. 

This very unfortunate occurrence is the result of the 
coughing and burning pains in the throat which occur during 
the first ctage of anesthesia. Impulses are thus sent to 
the vagus center in the medulla, which then sends impulses 
to the heart to make it beat slower. 

Such impulses usually cause fainting, which is a condition 
in which the heart stops beating for a few moments, but 
soon recovers again. In sudden chloroform death, how¬ 
ever, the heart muscle is poisoned by the chloroform; so 
that after it has suddenly stopped beating it does not con¬ 
tract again, and death results. 

If atropine is given before chloroform anesthesia, it 
occasionally acts as a safeguard against this dreaded acci¬ 
dent. The atropine paralyzes the nerve endings of the 
vagus nerve in the heart, and prevents impulses to slow the 
heart contractions from reaching it. 

When sudden chloroform collapse occurs, it is usually 
treated by giving atropine and other heart stimulants hypo¬ 
dermically, and massaging the chest over the heart. Every 
now and then patients recover after vigorous treatment. 

Symptoms of Chloroform Collapse 

When too much chloroform is given during anesthesia, 
the following symptoms usually result, in the order of their 
onset: 

1. The pulse becomes slow, weak and irregular, usually 
about 50 or 40 to the minute. 

2. Slow and shallow breathing. 

3. Pallor of the skin. 

4. The pupils are widely dilated, and do not react to 
light or accommodation. 

5. The pulse and breathing become still slower, and the 
patient dies from paralysis of the heart. 

Treatment 

x. Stop the anesthesia, and take the mask away as soon 
as the slow and weak character of the pulse is noticed. 

2. Stimulants such as atropine, caffeine, strychnine, etc., 
are usually given. 

3. Give artificial respiration. 

4. Elevate the foot of the table. 

2. Delayed Chloroform Poisoning 

This form of chloroform poisoning occurs occasionally. 
The symptoms appear about a few days after the anesthetic 
lias been administered. It is due to the destruction of 


ANESTHETICS 


many of the cells of the liver, kidneys, and heart, which 
then become filled up with fat globules (fatty degenera¬ 
tion). 

Symptoms. —Nausea and vomiting; the vomited matter 
containing bile. 

2. Jaundice. 

3. Delirium. 

4. Convulsions. 

5. Scanty urine, which contains albumen. 

6. Collapse (slow, weak pulse, slow, shallow breathing, 
etc.). 

The patient usually dies in a few days from profound 
collapse. 

Administration 

Chloroform is usually given by inhalation, by means of a 
mask covered with gauze, which is held over the patient’s 
nose and mouth. A few drops of chloroform are poured 
on the mask and allowed to mix thoroughly with air. Dan¬ 
gers of chloroform are best avoided by pouring the chloro¬ 
form very slowly, a drop at a time, and allowing the vapor 
to thoroughly mix with air. 

The nurse is often called upon to give chloroform during 
labor, in obstetrical cases. Very little chloroform should 
then be given, as in such cases it is only necessary to admin¬ 
ister the chloroform when the patient has severe pains. Com¬ 
plete anesthesia is not desired in these cases, as the uterine 
contractions are then lessened, and the birth of the child 
is thus retarded. The pulse and breathing should be watched 
very carefully throughout the anesthesia. 

Uses 

Besides its use as an anesthetic, chloroform is given: 

1. To stop convulsions (by inhalation). 

2. To check diarrhea and to lessen colic (by internal 
administration). 

3. Chloroform liniment is frequently used as a local 
application to relieve pain. 

Preparations 

Chloroform; dose one to fifteen mimims. 

The dose of chloroform for anesthesia, varies with the 
patient and the degree of anesthesia desired. 

Chloroform should always be kept in brown bottles, as it 
is readily decomposed into dangerous substances by the 
action of light. 

Spirit of Chloroform; dose 30 to 60 minims. 

This contains 10 per cent, of chloroform. 


ANESTHETICS 


Emulsion of Chloroform; dose half an ounce to one ounce. 

This contains 4 per cent, of chloroform. 

Chlorodyne; dose 5 to 30 mimims. 

This contains chloroform, ether, hydrocyanic acid, mor¬ 
phine and cannabis indica. 

Chloroform Liniment. —This consists of soap liniment and 
chloroform, and contains 30 per cent, of chloroform. 

Compound Chloroform Liniment. —This contains chloro¬ 
form, oil of turpentine, laudanum, tincture of aconite, and 
soap liniment. 


COMPARATIVE ACTION OF ETHER AND CHLOROFORM 


ETHER 

1. Inflammable 

2. Cools the skin 

3. Unpleasant to take 

4. Anesthesia induced with 

larger quantities, and 
not as deep 

5. Marked excitement stage 

6. Pulse rapid and strong 

7. Skin bright red in color 

8. Suitable in cases where 

the heart action is weak 
or where the kidneys 
are diseased 


9. Respiratory collapse 


CHLOROFORM 

1. Not inflammable 

2. Burns the skin 

3. More pleasant to take 

4. Deeper anesthesia induced 

with smaller quantities 

5. Little or no excitement 

stage 

6. Pulse slow and weak 

7. Skin pale 

8. Suitable in cases where the 

lungs are diseased or in 
drunkards 


Dangers 

| 9. Cardiac collapse 


After-Effects 

10. More vomiting 10. Less vomiting 

11. Apt to cause pneumonia 11. Apt to cause delayed 

chloroform poisoning 


ETHYL BROMIDE 

Ethyl bromide or bromide of ether, is a colorless liquid 
which evaporates easily. It has a disagreeable, sweetish 
taste, and an ethereal odor. 

Ethyl bromide is used to produce anesthesia, especially 
for short operations, or to begin an ether anesthesia. Its 
effects are similar to those of chloroform, and it has the 
same weakening action on the heart. When its administra- 









ANESTHETICS 


tion is stopped, consciousness returns very quickly, and 
the patient feels quite weak. It is usualy given as a con¬ 
centrated vapor, mixed with very little air. 

It should be kept in brown bottles, as it is decomposed 
very easily by the action of light, forming dangerous sub¬ 
stances. 


ETHYL CHLORIDE 

Ethyl chloride, chloride of ether or kelene, is formed by 
the action of hydrochloric acid gas on alcohol. It evap¬ 
orates very easily. It usually comes in special glass con¬ 
tainers, with a long, pointed tip, which is broken off or 
unscrewed. A fine stream of vapor then shoots out, which 
is directed on the mask; or, for local anesthesia, on the skin. 

Local action: —Because it evaporates very easily, ethyl 
chloride freezes the skin over which it is applied, producing 
local anesthesia of the part. Minor surgical operations 
can be performed under such local anesthesia. It should 
be applied until the tissues become white and hard, then 
stopped; if it is continued after this effect is obtained it is 
apt to injure the tissues. 

General Action. —Ethyl chloride is also used as a general 
anesthetic.- It produces anesthesia very rapidly, usually in 
about i to s minutes. 

Its effects are similar to those of chloroform, but it does 
not cause complete muscular relaxation. The pulse is slow 
and weak, and the breathing is deep. The patient usually 
recovers from the effects very rapidly. It is usually given 
to start an ether anesthesia. It is not suitable for pro¬ 
longed use, because it weakens the heart even more than 
chloroform and it does not cause complete muscular relaxa¬ 
tion. 


PENTAL 

Pental is a colorless liquid made from fusel oil. It has 
been used to produce anesthesia for short operations, and 
it produces no after-effects. Its effects are similar to 
those of ether or chloroform, but it does not cause much 
muscular relaxation. It has no effect on the heart or res¬ 
piration. It occasionally causes twitchings of the muscles, 
or convulsions, even during anesthesia. 

METHYLENE BICHLORIDE 

Methylene bichloride is an inflammable, colorless fluid 
which has an odor like chloroform. Its effects are similar 
to those of chloroform. It produces rapid anesthesia which 
soon wears off. It slows and weakens the heart action. 


ANESTHETICS 


ANESTHETIC MIXTURES 

The following preparations are mixtures of various anes¬ 
thetics. They are said to have various advantages over a 
single anesthetic. 


A. C. E. MIXTURE 

This consists of: alcohol i, ether 2, chloroform 3 parts 
by volume. 


ANESTHOL 

This is a mixture of: chloroform 36, ether 47, ethyl 
chloride 17 per cent. 

This mixture is said to have the same boiling point as 
the blood, and therefore to be easily excreted. The dangers 
of chloroform are thus said to be avoided. 

When these mixtures are given, the ether and the ethyl 
chloride evaporate more quickly than the chloroform. 

The anesthetist is then giving concentrated chloroform, 
instead of a diluted mixture. Dangerous symptoms are 
thus more apt to follow, especially in warm weather, since 
the ether and other ingredients evaporate more easily than 
the chloroform. 

SOMNOFORM 

This is a mixture of: ethyl chloride 65, ethyl bromide 5, 
methyl chloride 30 per cent. 

NITROUS OXIDE GAS (LAUGHING GAS) 

Nitrous oxide gas is a colorless gas without any odor. It 
is made by distilling ammonium nitrate. The gas is passed 
through water, and collected in small metal cylinders, in 
which it usually comes for practical use. It is the safest 
and most pleasant anesthetic known. 

Appearance of the Patient. Nitrous Oxide Anesthesia.— 
A few seconds after inhaling nitrous oxide gas, the patient 
usually feels rushing, drumming or hammering noises in the 
ears, the sight becomes indistinct, and he has a feeling of 
warmth and comfort all over the body. The arms and legs 
move constantly about, the patient is bright, lively, very 
jolly, and bursts out into fits of laughter (hence the name 
“laughing gas”). These symptoms last for about 2 or 3 
minutes and then the patient feels drowsy, falls asleep, and 
loses all sensibility. 

During the anesthesia, the face is dark red in color, 
often blue, the breathing is deep and snoring in character, 

the pulse is slow, strong and tense, and the blood pressure is 
very high. If the nitrous oxide is judiciously mixed with air, 
the anesthesia can be kept up for a half to one hour. 


ANEURYSM 


As soon as the mask is taken away, however, the patient 
becomes conscious in about i to 3 minutes, and has no after¬ 
effects, except perhaps a slight headache, which may persist 
for a few hours. 

Nitrous oxide does not relax the muscles, so that pro¬ 
longed abdominal operations cannot be performed under 
its anesthesia. 


Excretion 

Nitrous oxide gas is eliminated from the body in a few 
minutes by the expired air. 

Poisonous Effects 

When too much nitrous oxide is given, the following 
symptoms are produced, because the hemoglobin is unable 
to obtain its necessary oxygen. The blood is then impure 
and is poisonous to the brain and other organs of the body. 

Symptoms. —x. The face is blue in color. 

2. The breathing is difficult and deep. 

3. Slow, strong pulse, with very high blood pressure. 

4. Convulsions. 

These symptoms disappear as soon as the nitrous oxide is 
stopped. 

Administration 

Nitrous oxide gas is usually given by inhalation, by means 
of a specially constructed apparatus, consisting of a mask 
attached to a large rubber bag, which is filled with the gas 
from a metal container. 


Uses 

Nitrous oxide gas is used to produce anesthesia for short 
surgical operations, and to begin ether anesthesia, so as 
to avoid its unpleasant symptoms and excitement stage. 

It is frequently given together with oxygen for a pro¬ 
longed anesthesia. 

ANESTHETIC MIXTURES 

See Anesthetics. 

ANESTHOL 

See Anesthetics. 

ANEURYSM 

Aneurysm is due to a diseased condition of the arteries 
causing them to bulge where the wall is thin and is accom¬ 
panied by symptoms of pressure on neighboring structures— 
the lungs, bronchus, trachea, esophagus (with difficulty in 


ANGINA PECTORIS 


swallowing), veins, ribs, sternum or spine, etc. Pressure, 
constant pulsation, and corrosion of bone cause very severe, 
persistent, boring pain. The danger in aneurysm is sudden 
death from rupture of the diseased artery. 

The Nursing Care is to avoid all conditions which will 
tend to raise the blood pressure or increase the force of 
the heart-beat. 


ANGINA PECTORIS 

This is a name given to an attack of acute distress in the 
chest, which consists of at least three elements, namely, 
pain, faintness, and a sense of dying. 

The patient, usually a man past middle age, under the 
influence of exertion or excitement, or on meeting a cold 
wind, is suddenly seized with pain in the chest, which is 
severe, violent, or even excruciating, and sharp or neu¬ 
ralgic in character; it passes upwards and backwards into 
the neck and left scapular region, and down the left arm 
possibly as far as the fingers. Therewith a sense of faint¬ 
ness overspreads the patient; and he feels that the action 
of the heart is disturbed or arrested, that the chest is op¬ 
pressed or grasped, and that he is dying. Voluntary move¬ 
ment is arrested; the sufferer stands still or clings to the 
nearest support; the breathing is feeble or arrested, with a 
feeling of want of breath; his countenance is pale, anxious, 
distressed, or imploring; the lips are pallid or livid; the 
surface is covered with a cold sweat. The pulse varies: it 
may be regular or irregular, frequent or infrequent; its 
force is feeble. After a period of a few moments the 
attack passes off, leaving a sense of relief, but exhaustion 
and local soreness; or the patient dies in the brief paroxysm. 
If he recover, the angina returns after an uncertain 
interval once or more often; ultimately it proves fatal. 

ANKLE, STRAPPING OF 

To Strap the Ankle.—Strapping is applied to the ankle to 
support and immobilize a sprained ankle. Before applying 
the strapping the foot is supported and placed in the proper 
position, that is, flexion and inversion of the ankle. The 
patient may hold the ends of a bandage which encircles 
the ball of the foot in order to maintain this position during 
the application. 

The strapping consists of vertical straps which extend under 
the foot and up over the ankle and leg on either side. These 
alternate with horizontal straps which extend around the 
heel and back of the leg and over the ankle and foot on 
either side. The width of the straps used is usually one 


ANKLE, STRAPPING OF 

inch. The length of the horizontal straps may be from 
twelve to fifteen inches or more, depending upon the length 
of the foot. The length of the vertical straps depends 
upon the extent of the strain and the portion of the limb 
necessary to immobilize. 

The method of applying the strapping is determined by 
the anatomical formation of the ankle joint as the purpose of 
the application is to immobilize this joint. It is a hinge 

joint, the chief motion being upward flexion, and extension. 
It is formed by the astragalus and the external and in¬ 

ternal malleoli (commonly called the ankle-bones) which 
clasp the astragalus on either side. The strength of the 
ankle joint is due largely to the lateral ligaments attached 
to these bones and to the many closely associated tendons. 
In sprains of the ankle it s usually these tendons and liga¬ 
ments which are strained or lacerated. In strapping the 

ankle, therefore, the attention should be directed to afford¬ 
ing support and limiting the motion about the heel and 
malleoli. 

The center of the first vertical strap should be placed 

under the foot so that when applied to the leg it will pass 
directly over the external and internal malleoli on either 
side. The center of the first horizontal strap should then 
be placed behind the ankle so that when applied it will 
pass* directly over the malleoli on either side. The hori¬ 
zontal straps should be made to cross on the instep; this 
gives added support and helps to immobilize the joint. 
The vertical straps must be applied with downward pressure 
on the outside of the foot and firm upward pressure on the 
inside or arch of the foot. The vertical turns applied alter¬ 
nate* with the horizontal straps in each case crossing each 
other in an even line working toward the heel. Each strap 
overlaps one-third or one-half the preceding one. The straps 
are continued until in each case the tip of the heel is 
reached. Horizontal straps may also be applied higher up 
around the ankle, depending upon the degree of immobili¬ 
zation desired. 

The center of a vertical strap should then be placed 
beneath the sole of the foot near the center of the arch 
and firm traction made on the upward turn on the inside 
or arch of the foot to further strengthen the support. Sev¬ 
eral horizontal straps should also be applied over, above, 
and below the malleoli to further limit motion. The last 
strip should be applied directly over the tip of the heel, 
so that it is completely covered, and carried upward with 
firm traction so as to cross in front of the ankle. A short 
strip should cover the ends of the vertical strips to keep 
them from curling. 


ANOCI-ASSOCIATION 

ANOCI-ASSOCIATION 

See Shock. 


ANOPHELES 

See Mosquitoes. 


ANTHELMINTICS 

Anthelmintics are drugs which are principally used to 
destroy or expel intestinal worms. The drugs which destroy 
these worms are often called vermicides, and those which 
expel them, vermifuges. This difference in their action 
really depends, however, upon the amount of drug given, 
and how soon afterwards the bowels are moved. Thus, a 
large dose of one of the anthelmintics, if it remains in the 
intestine, will destroy, while a smaller dose will merely 
expel the worm. 

With the exception of pelletierine, which has a specific 
action on tape worms, most of the anthelmintics do not 
affect the worms selectively. 

All the anthelmintics are poisonous both to the worm and 
to the patient, but they are very slowly absorbed, so that 
their poisonous action is manifested mainly on the worm. 
Occasionally, if they are not followed by a cathartic, the 
drugs may be absorbed, and poisonous symptoms then 
result. 

The anthelmintics are best classified according to the 
particular worm for which they are used. 

1. For Tape Worms, or Taeniae: Aspidium; Cusso; Pepo; 
Kamala; Granatum; Pelletierine. 

2. For Round Worms, or Lumbrici: Santonin; Spigelia; 
Chenopodium; Azedarach. 

3. For Thread Worms, Seat Worms or Ascarides: 

Quassia; Alum; Sodium Chloride; Tannic Acid; Calumba; 
Lime Water; Vinegar. 

4. For Hook Worms, or Uncinariae: Thymol; Naphthol; 

(Calomel); Chenopodium. 

The diagnosis of the form of worm is usually made by 
finding the characteristic eggs in the stools. 

Administration 

In giving any of the anthelmintics, it is important that 
the following routine measures be carefully carried out: 

1. The patient should be given a very light diet, a day or 
two before the drug is administered, or better still, no food 
should be given for twenty-four hours before. 

2 . The bowels should be thoroughly moved with a light 
laxative, the day before administration. 


ANTIPHLOGISTIN 

3. The drug should best be given early in the morning 
on an empty stomach. 

4. About four to eight hours after the administration, a 
brisk cathartic such as calomel or castor oil, should be given, 
to expel the worm. Occasionally a cathartic like calomel 
is given together with the drug. 

No food should be given until the bowels have moved. 

ANTHRASOL 

This is a colorless coal tar which has been freed from pitch, 
coloring matter and other substances and is then mixed with 
juniper tar. It is used as an antiseptic for the skin, to 
destroy parasites and to soothe the skin. It is usually given 
in ointments of 5 to 30 per cent, in various skin diseases. 

ANTIFEBRIN 

See Acetanilid. 

ANTIFORMIN 

This is a strongly alkaline solution of sodium hypo¬ 
chlorite. It rapidly dissolves the bodies of all bacteria, ex¬ 
cept the tubercle bacilli. It dissolves all secretions such as 
sputum and also destroys unpleasant odors. It is there¬ 
fore a disinfectant, antiseptic and deodorant. It is said 
to be a stronger disinfectant than carbolic acid. It is also 
used in testing the sputum and other secretions, for tu¬ 
bercle bacilli. Antiformin is used externally in 2 to 10 
per cent, solutions, and as a spray in 1:1000 solutions. 

ANTIPHLOGISTIN 

Antiphlogistin is a clay-like poultice (cataplasma kaolini) 
consisting of boric acid, oil of peppermint, methyl salicylate, 
thymol, glycerin and kaolin, a clay-like substance, consisting 
of aluminium silicate. 

Effects of the Application.- —These are due largely to the 
moist heat. It is said to have less power as a counter- 
irritant and to retain the heat for a shorter time than a 
flaxseed poultice. 

Conditions in which Antiphlogistin is Commonly Used: 

1. In inflammatory diseases of the chest, such as pleurisy 
and bronchitis. The effects produced are similar to those 
produced by a flaxseed poultice or mustard paste. 

2. In toothache, when applied to the face, the poultice 
frequently gives great relief. 

3. In inflammation of glands and joints to relieve pain 
and swelling. 

Method of Application. —The required amount of anti- 


ANTIPYRETICS 


phlogistin is placed in a small receptacle, which is then 
allowed to stand in a basin surrounded by boiling water until 
the desired temperature is reached. The water is kept 
boiling until the antiphlogistin is thoroughly heated. It is 
then spread on muslin or old linen and applied directly to 
the part. A binder or bandage is used to hold the poultice 
in place. As the virtue lies chiefly in the heat, the poultice 
may be covered by flannel and a hot-water bag may be 
used to increase and retain the heat. 

ANTIPYRETICS 

Antipyretics are drugs which are used principally to lower 
the body temperature. 

Drugs lower the temperature in three different ways: 

1. By lessening the production of heat. This is accom¬ 
plished by such drugs asi quinine, morphine, aconite, etc., 
which lessen the muscular and other activities of the body. 

2. By increasing the elimination of heat. Drugs like 
pilocarpine or morphine which produce sweating, and drugs 
which widen the blood vessels of the skin, such as the 
nitrites, or the spirit of nitrous ether, reduce the tempera¬ 
ture in this way. 

3. By setting the heat regulating center for a tempera 
ture nearer normal, so that the excessive heat is eliminated. 
When the temperature is normal, these drugs produce no 
effect. The analgesic antipyretics act in this way. 

ANALGESIC COAL TAR ANTIPYRETICS 

The drugs belonging to the coal tar group were* originally 
used to lower temperature. They are now principally used 
to relieve nervousness, headache and pain. 

Appearance of the Patient 
(Antipyrin, Acetanilid, Phenacetin) 

About fifteen minutes to half an hour after an average 
dose of phenacetin is given, the patient is relieved of neural¬ 
gic pains or headache from which he may have been suffer¬ 
ing. If he has temperature, it may be reduced about three 
degrees or even to normal in several hours, accompanied by 
profuse sweating. The pulse and respiration are usually 
not very much affected. The skin is flushed and may be 
moist. 

Idiosyncrasies 

In some individuals, such as those that are anemic, or 
those weakened by prolonged illness, the following unusual 
symptoms occasionally occur: 


ANTIPYRETICS 


1. Skin eruptions: redness and itching, often swelling of 
the face and eyelids, which may last for several days. 

2. Nausea and vomiting. 

3. Cyanosis (especially after acetanilid and phenacetin). 

4. Collapse. 

5. Dizziness. 

Many patent headache powders contain coal tar anti¬ 
pyretics, and these frequently produce poisonous effects from 
continued use. 


Poisonous Symptoms 

The symptoms of poisoning may follow a single overdose 
in which case they appear suddenly. Usually, however, they 
result from the continued use of some patent headache pow¬ 
der for the relief of headache. 

Overdoses of analgesic antipyretics cause the following 
symptoms: 

1. Cyanosis (blue color of the face and hands). 

2. Shortness of breath. 

3. Slow, weak pulse. 

The cyanosis is not as marked after antipyrin. 

With larger doses, in addition to these symptoms, there 
may be the following: 

4. Subnormal temperature. 

5. Muscular twitchings. 

6. Collapse. 

7. Stupor. 


Treatment 

Usually, stopping the drug is sufficient. In severe cases 
the following procedures are carried out: 

1. Keep the patient quiet. 

2. Wash out the stomach. 

3. Give demulcent drinks (oils, acacia, etc.). 

4. Give oxygen to relieve the cyanosis. 

5. Atropine and other stimulants are given. 

Habit Formation 

Many nervous patients get into the habit of taking various 
headache powders for the relief of nervousness and head¬ 
ache. The habit is most pernicious; not only because of 
the danger of poisonous symptoms developing, but because 
of the interference with the general health. The nurse 
should therefore discourage the use of these remedies, and 
only give them when other milder measures are of no avail. 
Continued use of the coal tar drugs causes the following 
symptoms: 


ANTIPYRIN 


1. Digestive disturbances. 

2. Nervousness. 

3. Restlessness. 

4. Sleeplessness. 

The last three symptoms occur especially when the drugs 
are suddenly discontinued. 

Administration 

The antipyretics are best given between meals in wine, 
iced brandy, syrup, or milk. 

The coal tar antipyretics or their derivatives should not 
be given together with caffeine. Sodium bicarbonate, how¬ 
ever, does tend to lessen the weakening action on the heart. 

And see Antipyrin, Acetanilid, Acetphenetidin, Pyra- 
midon, and Phenocoll. 

ANTIPYRIN 

Antipyrin is a white crystalline powder which is readily 
dissolved in water. 

Antipyrin; dose 5 to 20 grains. 

Antipyrin Salicylate (Salipyrin); dose 5 to 30 grains. 

This is a combination of antipyrin with salicylic acid. 
It is said to relieve rheumatic pains more efficiently than 
either of its constituents alone. 

See Antipyretics. 

ANTIRABIC VACCINE 

This is an emulsion of the spinal cords of rabbits which 
have been inoculated with rabies (hydrophobia) poison. 
After the animals have been inoculated, they are killed and 
their spinal cords removed. The cords are dried, ground 
and made into an emulsion in normal salt solution. This 
emulsion is used in the treatment and prevention of hydro¬ 
phobia. The treatment is begun with the injection of a weak 
emulsion of a cord which has been dried for a long time, 
and is followed by the injection of stronger emulsions (con¬ 
taining cords which have been dried for a shorter time.) 


ANTITOXIC SERUMS 

See Serums. 


APERIENTS 

See Cathartics. 


APHASIA 

Aphasia is a term which is applied to certain disturbances 
of function in the cerebral centers which have to do with 
language. These disorders are the result usually of some 


APOMORPHINE 


lesion which either interferes with or destroys the function 
of those centers where impressions of written and spoken 
words and their expression are stored in memory, and may 
be either sensory or motor. 

Sensory aphasia is shown by inability to comprehend 
spoken and written words. The patient can hear and can 
see, but does not understand. He is like one who hears a 
foreign language which is unfamiliar, or looks at symbols 
whose meanings are unknown; he cannot understand because 
there are no images in memory which correspond to what 
he hears and sees, and so he cannot interpret them. The 
ability to recognize objects or recall their uses may also 
be lost. This disorder is not uncommon among the aged, 
and articles and objects of everyday familiarity are some¬ 
times put to most unusual and unsuitable uses. 

Motor aphasia is shown by inability to speak or to write 
words with which one has been familiar. The patient knows 
well what he wants to say or to write and recognizes the 
word when it is suggested to him, but because the memory 
of muscular control and coordination required to speak or 
to write the words is lost, he cannot express them. He has 
been likened to a banker who wants to open his safe and has 
lost the combination. 


APIOL 

Apiol is an oily liquid obtained from the root of ordinary 
garden parsley or Apium petrosinellum. It resembles cam¬ 
phor and is often called parsley camphor. 

Apiol is used to increase the menstrual flow, especially 
when the scanty menstruation is due to anemia and when 
the menstruation is painful. The dose is from three to ten 
grains. 

Apiol is given in capsules; most of which are imported 
from France. Each capsule contain four grains. There are 
a number of preparations of apiol combined with ergot and 
other substances. 

APOMORPHINE 

Apomorphine is an artificial alkaloid, made from morphine, 
one of the alkaloids of opium. 

Appearance of the Patient 

When a moderate dose of apomorphine is administered 
hypodermically, within ten to fifteen minutes after it is 
given the patient feels nauseated and vomits profusely. At 
the same time, there is a profuse secretion of tears, of mucus 
from the nose and bronchi, and the skin is covered with cold 


APOPLEXY 


perspiration. These symptoms are always produced by any 
drug which causes vomiting. There is usually a great deal of 
weakness after apomorphine is administered, at times very 
profound collapse: a rapid, thready pulse, slow and shallow 
respiration, cold perspiration and dilated pupils. The col¬ 
lapse has seldom been fatal, however. 

Internal action: Small doses often increase the secretions 
of all the mucous membranes without producing vomiting, 
and they are often given for this effect. 

Mode of action: Apomorphine produces vomiting, by 
causing the vomiting center in the brain to send impulses 
to the stomach to cause its muscle wall to contract and 
thereby expel its contents. 

Excretion: It is excreted by the stomach in the vomited 
matter. 

It is given as apomorphine hydrochloride; and the dose 
as an emetic is i/io to 1/5 grain; as an expectorant 
1/30 to 1/15 grain. 

Apomorphine is usually given hypodermically. 

APOPLEXY 

The Symptoms.—The patient may have a few minutes’ 
warning—headache, dizziness, ringing in the ears, specks 
before the eyes—but the attack usually occurs without 
warning. 

“In the typical apoplectic attack the condition is as fol¬ 
lows: There is deep unconsciousness; the patient can not 
be roused. The face is injected, sometimes cyanotic, or of 
an ashen-gray hue. The pupils vary; usually they are 
dilated, sometimes unequal, and always, in deep coma, inac¬ 
tive. If the hemorrhage be so located that it can irritate 
the nucleus of the third nerve the pupils are contracted 
(hemorrhages into the pons or ventricles). The respira¬ 
tions are slow, noisy, and accompanied with stertor. Some¬ 
times the Cheyne-Stokes rhythm may be present. The 
chest movements on the paralyzed side may be restricted, 
in rare instances on the opposite side. The cheeks are 
often blown out during expiration, with spluttering of the 
lips, the pulse is usually full, slow, and of increased ten¬ 
sion. The temperature may be normal, but is often found 
subnormal, and, as in a case reported by Bastian, may sink 
below 95 °. In cases of basal hemorrhages the temperature, 
on the other hand, may be high. The urine and feces are 
usually passed involuntarily. Convulsions are not com¬ 
mon.” (Osier.) 

Apoplexy and acute alcoholism are frequently confused. 
The following table (Hare) differentiates them: 


APOTHECARIES SYSTEM 


ALCOHOLISM 

Pulse rapid, compressible and 
weak. 

Skin moist, or relaxed and 
cool. 

Body temperature lowered. 

Pupils equally contracted or 
dilated; generally dilated. 

No hemiplegia. 

Breathing not so stertorous 
nor so one-sided in lips. 

No facial palsy. 

Unconsciousness may not be 
complete. 


APOPLEXY 

Pulse apt to be strong and 
slow. 

Skin hot and dry. 

Body temperature raised. 

Pupils unequal. 

Hemiplegia, one side moved, 
the other remaining motion¬ 
less. 

Respiration stertorous, the 
lips being inflated on one 
side on expiration. 

Facial palsy. 

Unconsciousness complete. 


“The odor of alcohol in the breath is no guide, as acute 
alcoholism may have caused the rupture of a cerebral blood 
vessel.” 

The Treatment. — (Dr. Hare).—The patient should be put 
to bed, in the recumbent position, with the head slightly 
elevated, the feet low. He should be kept absolutely quiet. 
An ice-cap or ice compresses should be applied to the head. 
Hot-water bottles should be applied around the body; a hot 
mustard foot bath may be given in some cases, to lessen 
the blood congestion in the head. Drastic cathartics are 
usually given to relieve cerebral engorgement. When vomit¬ 
ing occurs, the patient must be watched closely, as the 
stertorous breathing may draw in the half-ejected vomitus to 
the lungs. No stimulants are given. 

Later, when bleeding is checked and there is no danger 
of further bleeding, potassium iodide is frequently given to 
cause absorption of the exudate. After all inflammation 
has subsided, passive exercise, rubbing and massage are given 
to restore or prevent the wasting of the muscles of the 
extremities. Strychnine is also given to stimulate the spinal 
cord and reflexes, and to tone up the muscles. 

The diet must be carefully selected. Meats are excluded 
or given sparingly; no wines are given as they tend to 
cause cerebral congestion and a second rupture. 

The bowels must be kept open. 

APOTHECARIES SYSTEM 

See Weights and Measures. 










APPENDICITIS 

APPENDICITIS, NURSING IN 

The diagnosis confirmed, the nurse’s part in the prepara¬ 
tion for the removal of an appendix consists of; shaving the 
local field; obtaining a urine specimen; allowing no food 
after supper; and giving an enema the morning of opera¬ 
tion. In most cases a glass of lemonade may be given a 
few hours before the operation, for this not only is 
refreshing, but also is supposed to aid in the dimunition of 
the formation of mucus during the administration of the 
anesthetic. 

If the type of operation permits, the patient is placed on 
his side to render vomiting less dangerous. If the condition 
requires drainage the patient is placed in Fowler’s position 
and the pulse and respiration are watched every ten minutes 
until the patient is conscious. At stated intervals normal 
salt solution is given to supply the necessary body fluid and 
to give a general systemic influence. 

The patient’s comfort depends on: Frequent changing of 
position; the placement of pillows under the knees; protec¬ 
tion against draughts; the proper functioning of .the bladder; 
the alleviation of thirst; the relief from distention by the 
use of the rectal tube; and the protection against surgical 
infection. If pain persists, the nurse administers the sedative 
ordered so that the patient’s strength will be conserved and 
exhaustion prevented. 


AQUA FORTIS 

See NITRIC ACID. 

AQUA REGIA 

See NITROHYDROCHLORIC ACID. 

ARAROBA 

See CHRYSAROBIN. 

ARBUTIN 

See uva ursi, and chimapiiila. 

ARGENTUM 

See silver. 

ARGYLL-ROBERTSON PUPIL 

This is a condition in which the pupil of the eye reacts 
to accommodation, but does not react to light. This reflex 
should be tested in a good light. The condition is found in 
tabes dorsalis, general paralysis of the insane; syphilis of 
the brain, congenital syphilis, alcoholism, and some other 
conditions. 


ARSENIC 


ARGYRIA 

Argyria is a condition which results from p r olonged use 
of silver salts, but the condition is not very common at the 
present time. 

The silver salts are absorbed into the blood, and deposited 
in the various tissues of the body. Since silver salts turn 
a dark color on exposure to light, the skin turns a dark gray 
or slate color. The skin of the entire body or only various 
regions of it, such as the face or the gums, may be thus 
affected. 

To relieve the condition potassium iodide is usually given, 
but the results are not marked. 

ARGYROL 

Argyrol is a compound of silver oxide and proteins, 
containing 20 to 25 per cent, of silver. 

It is used locally as an antiseptic and astringent to mucous 
membranes, in 10 to 25 per cent, solutions; these are not 
injurious to the tissues. Argyrol should be very carefully 
used, as it stains linen a dark brown color. 

ARISTOL 

Aristol Thymol Iodide is a yellowish brown powder which 
is used like iodoform but it has a more pleasant odor. 

See Iodoform, 


ARSENIC 

When small doses of arsenic are given for some time, 
the patient feels better, stronger and is more active. He 
looks more robust, somewhat stouter and has a ruddier 
color. The appetite is better and the bowels move more 
often. The pulse is stronger, somewhat faster and the 
patient breathes somewhat deeper. In short, the patient 
feels better and stronger. 

Local Action: Applied to the skin, arsenic causes inflam¬ 
mation and pain. If it is allowed to remain on the skin for a 
longer time, the skin is destroyed and an ulcer remains 
(escharotic or caustic action). Arsenic is slightly antiseptic. 
It is easily absorbed from the injured skin. On mucous 
membranes, when applied locally, it also causes redness and 
pain, with subsequent inflammation and destruction of the 
tissues. 

Internal Action.—In the mouth, arsenic has a sweetish 
taste, causes redness of the lining membrane of the mouth, 
and increases the flow of saliva. 

In the stomach it causes a sense of heat, it increases the 
appetite and the secretion. 


ARSENIC 


In the intestines, it increases the secretion of the mucous 
membrane, and the peristalsis, thus causing movements of 
the bowels. 


Action after Absorption 

Arsenic is rapidly absorbed and it affects principally 
the blood and the tissues. 

Action on the Blood: Arsenic increases the number of red 
blood corpuscles by increasing their formation in the bone 
marrow. Since the red blood corpuscles in the blood are 
increased, they are able to carry more nourishment and 
more oxygen to the organs and tissues of the body, and to 
remove more waste products. Thus they increase the activity 
of all the organs of the body in the same way as iron does. 

Action on the Tissues: Arsenic prevents the tissues from 
being used up, by lessening their combination with oxygen. 
It therefore increases the growth and nutrition of the tissues 
and organs of the body. As a result of this action, if 
arsenic is taken for some time, the patient usually becomes 
somewhat stouter. 

Action on the Circulation: In the doses that arsenic is 
usually given, it makes the heart beat somewhat stronger, 
though the rate of the pulse is not much affected. This is 
the result of the improvement in the general condition. 

Action on the Respiration: By improving the general con¬ 
dition of the patient, the breathing is deeper and faster, 
the patient takes in more air, and therefore more oxygen 
fpr the larger number of corpuscles which the blood contains. 

Action on the Brain and Spinal Cord: The brain and 
spinal cord are somewhat more active, when arsenic is given 
for some time, because of the improvement of the general 
health. 


Excretion 

Arsenic is excreted mainly by the urine, also by the lining 
membrane of the stomach, intestines and bronchi. It is 
excreted very slowly and may therefore cause cumulative 
symptoms. 

Tolerance 

When arsenic is taken regularly in small quantities, the 
patients are able to take comparatively large quantities of 
the drug without getting poisonous effects. A patient is then 
said to have a tolerance for arsenic. This is due to lessened 
absorption which occurs from continued use. 

Women very often take arsenic for weeks or months at 
a time to improve their complexion and figure. Poisonous 
symptoms often occur as a result of such use. 


ARSENIC 


Uses 

Arsenic is used principally in anemia, to improve the 
condition of the blood. It is used especially in those forms 
of anemia in which the number of the corpuscles is dimin¬ 
ished. It is often given together with iron. 

Arsenic is also given for chorea (St. Vitus’ dance), and 
as a tonic, to improve the general condition of the patient. 
Some of the newer preparations of arsenic are given as a 
specific for syphilis. 

Acute Arsenic Poisoning 

This follows a single large dose of arsenic taken with 
suicidal intent or by mistake. Many rat and insect poisons 
contain large quantities of arsenic. 

Symptoms. —The following are the symptoms which occur 
in about fifteen minutes to an hour: 

1. Burning pain in the esophagus and stomach. 

2 . Profuse nausea and vomiting of bile stained serum 
containing small flakes of mucous membrane. 

3. Severe abdominal cramps. 

4. Profuse diarrhea, with watery, bloody stools containing 
small flakes of mucous membrane (rice water stools). 

5. Excessive thirst (due to loss of fluid). 

6. Scanty, bloody urine. 

7. Collapse: cold, moist skin, slow and shallow breathing, 
rapid, thready pulse, etc. 

8. Coma and convulsions may occur before death, which 
results in from six hours to two days. 

In some cases there may not be much nausea, vomiting or 
diarrhea. The patient suddenly goes into collapse, has a 
few convulsions and dies. 

If the patient recovers from the acute symptoms, paralysis 
of the muscles of the extremities may result, causing “drop 
feet” or “drop hands,” from which he usually recovers, 
however. 

Treatment.— x. Give iron hydroxide or iron hydroxide with 
magnesia until recovery. (See iron.) 

2. Wash out the stomach, thereby removing the compound 
of iron and arsenic. Induce vomiting if no stomach tube is 

at hand. 

3. Protect the mucous membrane of the stomach and the 
intestines by giving mucilaginous drinks such as milk, olive 
oil, etc. 

4. Give plenty of water. 

5. Later, bismuth, chalk or opium may be given for the 
diarrhea. 

6. Abdominal cramps are usually relieved by a hot water 
bag and by atropine. 


ARSENIC 


7. The collapse is usually treated with caffeine, atropine, 
strychnine, warm applications, etc. 

Cumulative Arsenic Poisoning 

Since arsenic is excreted much slower than it is absorbed, 
cumulative symptoms, or chronic arsenic poisoning is very 
common. It usually occurs from the continued medicinal 
use of arsenic preparations. It may also result from inhaling 
fumes of arsenic, in rooms papered with wall paper con¬ 
taining arsenic dyes, from wearing clothing dyed with 
arsenic, or by eating food colored with arsenic dyes. The 
following symptoms, in the order of their onset, are noticed 
after prolonged administration. Often the later symptoms 
appear before the earlier ones. 

Symptoms.—1. Itching of the eyelids. 

2. Redness of the conjunctiva of the eye. 

3. Puffiness about the eyes, especially in the morning. 

4. Sneezing, “running nose” (coryza). 

5. Tightness in the throat. 

6. Hoarseness. 

7. Los& of appetite, heaviness in the stomach, nausea and . 
vomiting. 

8. Skin eruptions: red spots, areas of brownish discol¬ 
oration (very often they look like freckles) on the face or 
the abdomen. Dark discolorations on the skin of the abdo¬ 
men, which look like pencil marks. 

In severe cases, the hair and nails may fall off. 

9. Cramp-like abdominal pains. 

10. Diarrhea, with “rice water” stools; the rice water 
appearance of the stools is due to small flakes of the lining 
membrane of the intestines which they contain. 

The following symptoms appear later and only in severe 
cases: 

11. Persistent headache. 

12. Pains around the knee, ankle, foot and hands. 

13. Redness and swelling of the hands and feet. 

14. Areas of skin, especially on the extremities, which 
are very sensitive to touch, to pain, to heat and cold. 

15. In severe cases there are paralyses of the extensor 
muscles of the hands and feet, resulting in “drop feet” and 
“drop hands.” 

Treatment of Chronic Arsenic Poisoning 

If the arsenic is stopped and cathartics given, the symp¬ 
toms usually gradually disappear. The paralyses must be 
treated by massage and electricity, until the muscles re¬ 
cover; which they usually do. 


ARSENOBENZOL 


Preparations 

Solution of Potassium Arsenite (Fowler’s solution); dose 
one to eight minims. 

1 his contains i per cent, of arsenic trioxide, potassium 
bicarbonate and tincture of lavender. 

Five minims of Fowler’s solution contain Y20 grain of 
arsenic trioxide. 

Solution of Sodium Arsenite (Pearson’s solution); dose 1 
to 8 minims. 

Solution of Arsenious Acid; dose x to 8 minims. 

This contains 1 per cent, of arsenic trioxide and dilute 
hydrochloric acid. 

Solution of Arsenious and Mercuric Iodides (Donovan’s 
solution) ; dose 5 to 20 minims. 

This is the strongest arsenic preparation. It contains 1 
per cent, each of arsenic iodide and of red mercuric iodide. 
It may cause symptoms of mercury poisoning. 

Arsenic Trioxide; dose %o to Y12 grain. 

Sodium Arsenate; dose Yeo to 1/12 grain. 

Arsenic Iodide; dose Y20 to Ye grain. 

Sodium Cacodylate; dose % to 1 grain. 

This is a compound of cacodylic acid, which is a compound 
of arsenic. It is given hypodermically and is said to cause 
no unpleasant symptoms. 

Soamin. —This is sodium arsanilate, and contains 22 per 
cent, of arsenic. It usually comes in tablets each containing 
x to 5 grains of soamin. 

Salvarsan “ 606 ”; dose 5 to 10 grains. 

Neosalvarsan; dose 5 to 10 grains. 

These are organic compounds of arsenic which are used 
as specifics for syphilis. They are given intravenously, as an 
intravenous infusion, or by deep injection into the muscles. 
Salvarsan has to be very carefully neutralized with an alkali. 
Both preparations come in closed glass tubes, containing 
nitrogen gas and the powder. 

Atoxyl 

This is Sodium Arsanilate, and oomes in tablets of half a 
grain for hypodermic use. 

Administration 

Arsenic preparations should be given well diluted in a 
large glass of milk after meals. 

ARSENOBENZOL 

See Salvarsan, and Arsenic (Salvarsan). 


ARSPHEN AMINE 


ARSPHEN AMINE 

See Salvarsan. 

ARTERIOSCLEROSIS 

Arteriosclerosis may be (i) either the effect or the cause 
of high blood pressure; (2) the effect of poisons in the 
blood, as in syphilis, typhoid, Bright’s disease, diabetes, gout, 
or constipation, etc., or (3) the effect of senile decay—the 
blood pressure is normally increased with old age. Strain, 
mental, physical or nervous, increases the tendency to 
arteriosclerosis or “hardening of the arteries.” 

The Nursing Car© and Treatment aim to avoid, as far as 
possible, conditions which aggravate the disease and cause 
contraction of the arteries or increased blood pressure. All 
excesses in exercise, food, drink, and habits should be 
avoided. The functions of the skin, the kidneys and 
bowels should be carefully regulated by warm baths, drink¬ 
ing water freely, and the avoidance of constipation. Exposure 
to cold contracts the blood vessels and should be avoided 
by regulation of the clothing, by warmth to the extremities, 
and hot drinks to relax the blood vessels. Old people in 
particular stand exposure to cold badly—cold air, baths, or 
being deprived of their customary clothing and surroundings. 
When not allowed to wear flannel underwear in bed they 
should have extra blankets or a hot-water bag and frequent 
massage to the limbs to restore the circulation and prevent 
cold and cramps, etc. When the arteries of the brain are 
affected, the danger of apoplexy must always be remembered. 
All causes of worry, excitement, anger or irritation must 
be avoided, as they greatly increase the supply of blood 
and the blood pressure in the brain, shown by the flushed 
face and prominent blood vessels. Slight, petty causes 
of irritation particularly upset the patient. The same is 
true in angina pectoris. Particular care should be taken 
to observe moderation in food, drink and exercise and to 
avoid constipation or foods which cause distention. Sudden 
death frequently occurs from “acute indigestion” combined 
with some unusual exertion and strain on the heart. Nitro¬ 
glycerin or amyl nitrite is usually ordered to dilate the 
blood vessels, and bromides or morphine to relieve the pain 
and to quiet and relieve the patient from the fear of impend¬ 
ing death. 


See Joints. 


ARTICULATIONS 


ARTIFICIAL FEEDING 

See Infant Feeding 


ASAFETIDA 


ARTIFICIAL RESPIRATION 

Schaefer’s method is the best. This has been described as 
rollows: “The patient is placed on the ground, with his 
face downward, and with a thick folded garment or pillow 
under the lower part of the chest. Care must be taken 
that the entrance to the mouth and nose is clear. The 
operator places himself ki a kneeling posture astride of 
the patient, facing the patient’s head, his knees being opposite 
the patient’s hips. He then places his hands flat over the 
back of the lower ribs, one hand on each side, and gradually 
throws the weight of his body forward, so as to make firm 
pressure on the lower ribs. By this means the chest is com¬ 
pressed and air is forced out of the lungs. The operator 
then brings his own body up into the semi-erect position, but 
still retaining his hands in position, thereby relaxing the 
pressure on the ribs, and enabling air to be drawn into 
the lungs by the elastic reaction of the chest wall. The 
process is repeated regularly about 15 times a minute, and 
should be continued for at least half an hour.” 

ASAFETIDA 

This is a gum resin obtained by incising the root of the 
Ferula narthex. It consists of a gum resin and a volatile 
oil which is the active principle. Asafetida is frequently used 
in India as a condiment. 

Action.—In the mouth: It has a very unpleasant nauseous 
taste, and an odor resembling garlic. 

In the stomach: It checks the formation and aids the ex¬ 
pulsion of gas (carminative action), and it increases the 
secretions. 

In the intestines: It increases the secretions and peristal¬ 
sis and helps to expel gas. It causes frequent movement of 
the bowels. 

It is used principally to remove gas from the intestines. 
It is frequently given in an enema. 

Because of its unpleasant taste, which causes a psychical 
effect, it is occasionally given to quiet hysterical patients. 


Preparations 

Emulsion of Asafetida; dose 4 to 8 drams. 

This is given by mouth, or in an enema; to relieve disten¬ 
tion. 

Tincture of Asafetida; dose 15 to 30 minims. 

Pills of Asafetida; dose 1 to 3 pills. 

Each pill contains 3 grains of asafetida. 


ASPHYXIA 


ASPHYXIA 

Asphyxia is a condition of unconsciousness due to suf¬ 
focation or interference of any kind with the oxygenation 
of the blood. 

The causes of asphyxia may be:— 

1. Mechanical interference with the entrance of air to 
the lungs which may be (i) inflammation and swelling of the 
throat and larynx or the formation of a membrane as in 
diphtheria; (2) edema of the glottis in diphtheria, tubercu¬ 
lous laryngitis, cardiac and renal diseases; (3) foreign bodies 
in the respiratory tract; (4) pressure on the trachea or 
bronchi from goitre, tumor or aneurysm; (5) water and 
mucus, etc., in the respiratory tract as in drowning. 

2. The inhalation of smoke, or poisonous gases such as 
coal gas or illuminating gas, or the fumes of ammonia, or 
nitric acid, or the inhalation of ether in a general anesthetic. 

3. Interference with the interchange of gases between the 
blood and air in the lungs as in diseases of the heart or 
lungs, and in poisoning from carbon monoxide in which the 
hemoglobin is saturated with the gas and cannot combine 
with oxygen. 

4. Weakness of the respiratory muscles, or convulsive 
spasms as in croup or whooping-cough, or paralysis as in 
diseases or injuries involving the upper part of the spinal 
cord. 

5. Weakness of the respiratory center in the medulla. 

6. Failure of the lungs to expand in the new-born. 

The Symptoms of asphyxia develop in three stages: In 
the first stage, the breathing is more rapid, labored, and 
distinctly audible. Respiratory muscles not used in quiet 
breathing are forced into action. The appearance of the 
patient is alarming—the lips are blue, the face congested, 
the eyes prominent and bloodshot and the expression is 
anxious. This stage lasts about one minute. 

The second stage is the stage of convulsions. This stage 
lasts less than one minute. 

The third stage is the stage of exhaustion. The patient 
becomes unconscious, the muscles flaccid and the pupils 
widely dilated. The pulse is almost imperceptible, due to 
heart failure. The inspirations are prolonged and sighing 
and the intervals between increase until breathing finally 
ceases. Death results from gradual exhaustion and paralysis 
of the centers in the medulla. The third stage may last three 
minutes or more. 

The Treatment. —The first step is to remove, if possible, 
any obstruction to the free passage of air. If the obstruction 
is due to fluid in the lungs and bronchi, as in drowning, the 


ASPHYXIA NEONATORUM 


patient’s clothing should be loosened about the neck, chest, 
and waist, and he should then be turned on his face, and 
his body raised at the waist-line by means of a folded blanket 
or clothing. Pressure should then be applied, with both 
hands spread out, upon the lower chest wall to expel water 
from the stomach and lungs, and to allow it to run out 
by gravity from the trachea and mouth. The nose, mouth and 
throat should be cleansed of mucus. 

In all cases of asphyxia, the treatment consists in removing 
anything which might interfere with breathing, in establishing 
natural respiration with the least possible delay, and in treat¬ 
ing the patient for shock. He should be kept warm and 
should have plenty of fresh air. His clothing should be 
loosened about the throat, chest, and waist, and his position 
must be such as to keep the air passages wide open for 
the admission of air, and to allow for the free expansion of 
the lungs. Foreign bodies (such as false teeth) or mucus 
should be removed from the mouth or throat. Artificial 
respiration should be begun without delay. See Artificial 

RESPIRATION. 

ASPHYXIA NEONATORUM 

In this condition the infant is born in a state of suspended 
animation—its heart continues to beat, but it makes no 
effort to breathe or to move. “Still-birth” is therefore not the 
same thing as the child’s being born dead, although death 
may supervene if prompt treatment is not applied. The term 
asphyxia strictly means pulselessness, and apnea is more 
correct as meaning absence of breathing. 

Causes interfering with the circulation of maternal blood 
through the placenta are (i) Premature Separation of the 
Placenta (accidental hemorrhage or placenta praevia); and 
occasionally (2) Tonic Contraction of the Uterus, which 
stops all placental circulation. 

Causes interfering with the circulation of the fetal blood 
through the placenta are (3) Pressure upon the Cord, as in 
breech delivery, or prolapse of the cord, or due to knots or 
tight coiling of the cord round the trunk or limbs. 

Other causes of asphyxia are (4) Premature Efforts to 
Breathe, stimulated by the cold air playing on the surface of 
the body in breech delivery while the head is still in the 
vagina. This results in the child sucking in mucus and 
liquor amnii from the vagina, and it may be drowned if 
not speedily delivered. 

(5) Severe injuries or compression of the fetal head, due 
to its passage through a narrow pelvis or the use of instru¬ 
ments, may so damage the respiratory center in the brain 
that the child makes no effort to breathe after its birth. 


ASPHYXIA NEONATORUM 


Indirectly, therefore, the causes of asphyxia are manifold, 
and it may be associated with any form of delayed or abnormal 
labor, and any form of fetal disease or abnormality. 

Varieties. —There are two outstanding varieties named 
according to the appearance of the child—the Livid or 
Cyanotic, and the Pallid or White. Many cases are interme¬ 
diate between these two forms, and the livid form gradually 
passes into the pallid if not effectually and promptly treated. 

(1) Asphyxia Livida .—This is much the more common type. 
The child when born is of a cyanotic blue appearance, the 
heart and cord beating slowly but often quite strongly, the 
cord full and thick, the muscles firm and tonic, the reflexes 
present. 

(2) Asphyxia Pallida .—In this rarer form the child is 
deadly white, the heart and cord beating feebly or perhaps 
imperceptibly, the cord empty and flabby, the muscles (includ¬ 
ing the sphincters) limp and relaxed, and the reflexes lost. 

Prognosis. —In asphyxia livida the prognosis is uniformly 
favorable, recovery being the rule if the case is properly 
treated. In asphyxia pallida, on the other hand, the outlook 
is not good, as the cause is often more serious. Even after 
recovery many children die of aspiration pneumonia, etc., 
within a few days. 

Treatment. —Livid or Cyanotic Form .—As long as the cord 
is beating strongly the child is obtaining oxygen through 
the placenta, therefore there is no immediate hurry to tie 
the cord. Hold the child up by the heels, and with the 
little finger covered with a small linen swab clear out the 
mucus from the throat and nose. A catheter may be used 
for this purpose, the mucus being sucked up. Once the 
throat is cleared we may stimulate the child to breathe, but 
it is a mistake to do this before clearing the throat, as the 
first breath would suck the mucus deeper into the bronchial 
tubes. 

A few gentle slaps on the buttocks and back, light friction 
over the chest, sprinkling with a few drops of cold water, 
usually suffice to start the child breathing and crying healthily. 
If, when the cord is being tied, the child is still blue, cut 
the cord and allow half an ounce or so of blood to escape 
before ligaturing. 

If this treatment fails, the condition becomes more grave, 
and requires to be treated like an asphyxia pallida. Indeed, 
persistent cases of cyanotic asphyxia tend to pass into the 
pallid form, the surface of the body gradually changing from 
purple to white as the condition becomes more serious. 

Asphyxia Pallida .—When the cord is pulsating feebly or 
not at all, the placenta is out of action, and therefore the 
cord should be cut at once to facilitate the manipulation of 


ASPHYXIA NEONATORUM 


the child. To save time only one ligature need be applied. 
Hold the child up by the heels and clear out the throat as 
before. Then immerse the trunk and limbs in a bath of 
water that is comfortably hot to the hand. Apply light 
friction over the heart, splash the chest front and back with 
a few drops of cold water, and every few seconds gently 
compress the chest with the hand. Clear out the throat from 
time to time if necessary. If these measures fail, and the 
heart is still beating no matter how slowly, persevere in the 
resuscitation. Dry the child with a warm towel, and apply 
one of the methods of artificial respiration. Of these the 
best is direct mouth-to-mouth insufflation, as described in the 
next paragraph. Try this for a few moments. Then replace 
the infant in the warm bath, for it is a first essential to 
keep up the body heat. Again apply friction to the chest, 
clear out the throat, and feel whether the heart is beating. 
If it is beating, repeat one or other process of artificial 
respiration and warm bathing alternately as long as the 
heart continues to beat. When the child revives, keep it 
warm and have it carefully watched for some time lest it 
should relapse. 

Methods of Artificial Respiration. —Direct Insufflation .— 
Blowing air directly into the lungs is frequently the most 
effective of all methods, as it forcibly opens up the glottis 
and the air vesicles of the lungs. 

The method may be carried out without any apparatus 
as follows: Lay the child on its back on a table, and place 
a clean, fine linen handkerchief over its mouth. Place the 
one hand over its epigastrium and with the other close its 
nostrils. Then, taking two or three long breaths so as to 
empty the lungs of carbonic acid, place the mouth over the 
child’s mouth and breathe into it. The hand over the 
epigastrium prevents the air passing into the stomach and 
perhaps rupturing it, while the other hand prevents the air 
passing out through the nose. The hand on the epigas¬ 
trium also feels when the chest is full, and when this is so, 
the chest is gently compressed and emptied. This maneuver 
is repeated a dozen to eighteen times a minute. The blowing 
must be gently done, otherwise the air vesicles may be 
ruptured. 

Schultze’s Method .—Dry the child and wrap it in a small 
warm towel to prevent it slipping out of the fingers. Hold 
the child, head up, grasping it by placing the fingers over 
the back and sides of the chest, the thumbs and forefingers 
encircling the axillae. Steady the child’s head between the 
wrists. Stand with the feet apart, and hold the child hanging 
down between the legs. See that you have a firm grasp of it. 
Then swing the child gently up to the level of your face. 


ASPHYXIA NEONATORUM 


At the end of this swing draw the arms in towards you a 
little, at the same time dropping them slightly. This causes 
the lower limbs of the child to fall over in front of the chest. 
At the same time compress the chest gently with the fingers. 
Then reverse the movement and swing the child down between 
your legs once more. Pause for a moment and then repeat. 
The double movement should be carried out at the rate of 
about twelve to eighteen times in the minute, but, as 
mentioned before, not more than six to eight swings should 
be done at a time. 

When the child is hanging down, it is in the position of 
inspiration. When its limbs fall over in front of the abdomen 
at the top of the .swing, their weight compresses the chest 
and causes a mechanical expiration. 

This method is a good one when carefully done, but it 



Schultze’s Method of Artificial Respiration. 

A. Inspiration. B. Expiration. 

is very open to abuse. The not inconsiderable risks of it 
are— 

(1) Violent and careless swinging may cause rupture of 
the liver, or hemorrhage into the other abdominal organs. 

(2) The child may slip out of the hands and be flung 
on the floor. This is due to not making sure that you have 
a firm grasp before you start to swing. The intervention of 
a small warm towel between the hands and the child’s body 
is a help in preventing this accident. 




AUTOINTOXICATION 


(3) Fractures of various bones have followed careless 
swinging. 

(4) The child’s body becomes rapidly cooled. The warm 
towel helps to prevent this, and the frequent plunging into 
a warm bath after every six swings or so. 

Rhythmic Traction on the Tongue is sometimes effective. 
The child is laid on its back and the tongue grasped with the 
fingers covered by a piece of linen, and pulled outwards 
twentv to thirty times per minute. 

ASPIDIUM 

See MALE FERN. 

ASPIRATION OF CHEST 

See thoracic aspiration. 

ASPIRIN 

See salicylic acid. 

ASTIGMATISM 

See accommodation. 

ATOPHAN 

Ato-phan is a white, crystalline substance which is made 
chemically from various other complex substances. 

Atophan has a specific action in acute gout. It relieves the 
pains around the joints very promptly. It increases the 
secretion of urine and the amount of uric acid contained in 
it. Beneficial effects have also been obtained from its use in 
other chronic joint affections, such as rheumatism, etc. 

It is not a poisonous drug, and is therefore safer than col- 
chicum. 

Preparations 

Atophan; dose 8 to 15 grains. 

Novatophan; dose 8 to 15 grains. 

Paratophan; dose 8 to 15 grains. 

ATOXYL 

See arsenic. 

ATROPINE 

See belladonna. 

AURA 

See epilepsy. 

AUTOINTOXICATION (POST-OPERATIVE) 

Antointoxication is closely allied to tympanites. The 
patient absorbs certain products of fermentation and decompo- 


AUTOINTOXICATION 


sition from the gastro-intestinal tract, resulting in a slight 
degree of temperature usually associated with headache and 
general malaise. This is ordinarily relieved by a movement 
of the bowels, procured by an enema, and a cathartic. This 
condition is never very serious, and never alarming. See 
TYMPANITES. 


AZEDARACH 

Azedarach is the bark of the root of Melia azedarach, an 
Eastern plant. 

It is used in the South as a remedy for round worms. 
It is usually given as a decoction, made from two ounces of the 
plant to a half pint of water, of which half an ounce is 
given every two hours. It is said to produce the same 
poisonous effects as spigelia. See Anthelmintics. 


B 


BABY, FIRST ATTENTION TO 

See Labor, Management of. 


BACILLARY DYSENTERY 

See Dysentery. 


BACTERIAL VACCINES 

See Vaccines. 

BACTERIOLYTIC SERUMS 

See Serums. 


BAKING 


See Food, Preparation of. 


BAKING 

Baking is used as a therapeutic measure in (j) inflamma¬ 
tory joints due to rheumatism; (2) inflammatory muscles; 
(3) chronic inflammation of joints with an exudate; (4) 
gonorrheal arthritis; (5) gout. 

Baking is contra-indicated in acute rheumatic fever or in 
any febrile condition, in acute inflammatory conditions, and 
in cases in which the skin of the part is broken or diseased. 

Effects of Baking. —The local application of hot air usually 
brings great relief and comfort to the suffering patient. It 
increases the temperature of the part because the hot air 
surrounding it prevents the loss of heat. The tendons, liga¬ 
ments, and fascia are softened and expanded; the muscles 
are relaxed; pain is relieved, stiffness is removed, and the 
function of the part is restored. 

The Apparatus .—There are several forms of apparatus on 
the market. The chambers are metal boxes lined with 
asbestos and containing an asbestos board or rest for the 
arm or limb. A thermometer is suspended in the chamber. 

The temperature of the air varies from 200° F. to 300° F. 

The duration of the treatment varies. It may be resorted 
to daily or several times a week and each treatment may 


BALLOTTEMENT 


last from a few minutes to several hours (usually one hour), 
depending upon the temperature used, the sensations of the 
patient and the nature of the case under treatment. 

Method of Procedure. —First see that the room is warm 
and that the patient is protected from chilling before, during, 
and after the treatment. The patient must be undressed 
(having on a gown, wrapper, stockings and slippers) for the 
treatment, as it causes general profuse perspiration. Several 
blankets should be used to protect him from getting cold. 
His position and the position of the part being baked should 
be made comfortable and all straining of muscles from a 
cramped position avoided. Cold applications should be 
applied to the head before, and during the treatment. 

The asbestos board or rest (which becomes very hot) should 
be covered by a pad of linen. The arm or limb must be 
protected by a properly fitting flannel covering and not 
allowed to come in contact with either the asbestos or metal. 
No rings should be worn by the patient and no pins used 
in the protector as all metals are good conductors of heat 
and would burn the patient. The asbestos covering which 
guards the opening and a blanket should be snugly drawn 
around the limb. The temperature of the bath must be 
raised gradually. Both the temperature and the duration 
of the treatment may be increased from day to day as the 
patient becomes adjusted to it. The patient should never 
be left alone and should be watched closely for signs of 
weakness. He should be encouraged to drink fluids before 
and during the bath in order to encourage the elimination 
of waste products and to prevent the body tissues from 
suffering owing to the loss of so much water. 

At the end of the bath the limb should be well wrapped 
up with wool, covered with rubber cloth, and flannel, to 
continue the effect of the bath. Some doctors advise that 
the whole body have a short cold application such as a cold 
towel rub, followed by careful drying and thorough rubbing. 
If the affected part will bear rubbing, some doctors also 
advise a very brief (four to thirty seconds) dry cold applica¬ 
tion (wring towel very dry before applying) followed by 
drying and vigorous rubbing. This acts as a tonic to the 
passively dilated blood-vessels, and prolongs the effects of 
the bath. In some cases the patient is put to bed between 
blankets, dried and given an alcohol rub. Because of the 
free perspiration and weakening effect of the treatment 
the patient should always rest in bed following it. 

BALLOTTEMENT 

Ballottement is a French word meaning the tossing of 
a ball, and is applied to a method of examination by which 


BALSAM OF TOLU 


the fetus is moved passively inside the uterus. Ballottement 
is performed as follows. The woman is placed on her 
back with the head and shoulders slightly raised on pillows. 
Two fingers are introduced into the vagina and placed in 
front of the cervix, where the firm head of the fetus may 
generally be felt resting. The other hand is placed firmly 
on the fundus of the uterus. The woman is asked to take 
a deep breath and hold it for a moment or two. The 
fingers in the vagina then give a sharp jerk upwards, and 
the fetal head is felt to rise up in the liquor amnii and leave 
its contact with the fingers. After a moment it is again felt 
settling down against the fingers, sometimes with a distinct 
tap suggestive of a ball stopping. 

This is usually regarded as a positive sign of pregnancy, 
and to a careful observer is so. But mistakes have been 
made over similar signs given by a stalked fibroid tumor, or 
a stone in the bladder. Therefore, although it is all but 
an absolute sign, it cannot be classed along with the fetal 
heart-beat or active movements. 

Internal ballottement can be obtained from the fourth to 
the seventh month. Before that the fetal head is too soft 
to be well felt, and later the quantity of liquor amnii is 
relatively too small. 


BALSAMS 

Balsams are resins or oleoresins which contain benzoic or 
cinnamic acid. And see benzoic acid. 

BALSAM OF PERU 

Balsam of Peru is a dark brown syrupy fluid, which does 
not dissolve in water. It is a balsam which oozes from the 
trunk of the Toluifera pereirse, a tree growing in Central 
America and India. 

Balsam of Peru is used in the form of gauze saturated 
with the balsam. This is applied to wounds and ulcers as 
an antiseptic, and to promote healing by increasing the 
growth of granulation tissue. 

When given internally, it acts as an antiseptic in the 
stomach and intestines, and aids in the expulsion of gas. 
After absorption it. increases the cough and expectoration. 
Its effect is due to the benzoic acid which it contains. Dose, 
5 to 15 minims. 


BALSAM OF TOLU 

Balsam of Tolu is a reddish-yellow, sticky, semi-solid 
substance, which dissolves in alcohol, but not in water. 


BANDAGES 


Its action is due to the benzoic acid which it contains. 

It is used principally as an expectorant. It forms an 
ingredient of many cough mixtures. 

Preparations 

Balsam of Tolu; dose 5 to 15 grains. 

Syrup of Tolu; dose 30 to 60 minims. 

BANDAGES 

A bandage may be defined as a piece of flexible material 
suitably fashioned for application about something as a 
covering, a reinforcement, or a compressor. 

Use of Bandages 

The purposes for which bandages are used may be summed 
up under these headings: 

1. To hold dressings, splints, and other appliances in place. 

2. For support, as in the case of sprained joint, etc. 

3. For pressure, as in the case of a bleeding "vessel, etc. 

Forms of Bandages 

Those in more common and standard use are: (a) The 
Roller Bandage, (b) The Triangular Bandage, (c) The Many- 
Tailed Bandage. 

(a) The Roller Bandage is merely the bandage material 
which has been cut into a long, narrow strip and rolled up, 
from one end to the other, into a compact cylinder so that 
it may be more easily and quickly handled and used. 

The roller bandage is by far the more commonly used one, 
and the one which is adaptable to the greatest variety of 
purposes. 

(b) The Triangular Bandage is simply a three-cornered 
piece of material the shape of the half of a square which has 
jeen cut from one corner to the diagonally opposite one, 
or which has been folded double along this line. Aside from 
one or two uses which will be encountered later, this bandage 
will be employed only as a substitute for the roller bandage 
in emergency cases, as it is more easily and quickly improvised 
than the roller one. 

(c) The Many-Tailed Bandage is made in a number of 
slightly varying designs but - consists essentially either of a 
single oblong piece of material which has been split at each 
end into two or more tails, or of a combination of two 
or more strips whose edges have been overlapped and stitched 
together in the middle, leaving the ends free. The many¬ 
tailed bandage serves few purposes for which the roller 


BANDAGES 


bandage will not be preferred, but it has wide application 
and constitutes a very serviceable emergency form because 
it is simple to make and easy to apply. 

(a) Roller Bandages are made of: Gauze; Muslin; Canton 
flannel; Woolen flannel; “Elastic” webbing (woven cotton 
bandage); Rubber; Crinoline impregnated with starch—the 
“starch bandage”; Crinoline impregnated with plaster of 
Paris—the “plaster of Paris bandage.” 

Gauze is the most frequently used material. Its advantages 
are that it is light in weight, cool, and so flexible that it is 
easily fitted to all parts. It cannot be washed or used a 
second time with satisfaction and is therefore a relatively 
expensive material. 

Muslin is very suitable where greater strength is needed, as 
in the application of the larger splints, in the arrest of 
hemorrhage, and in other cases where more pressure is 
required than gauze will supply. It withstands washing 
and repeated usage. 

Canton flannel, because of its combined softness to the 
touch and its strength, is often used where pressure is 
necessary over a sensitive part. It is also useful as padding 
underneath a plaster or starch bandage. 

Woolen flannel is used chiefly for its softness of texture. 
It, too, is washable and can be used repeatedly. 

“Elastic” webbing is a specially woven cotton material 
which furnishes the advantages of the adaptability and a 
large part of the lightness of the gauze, a measure of the 
strength of the muslin, the softness of the flannel, and the 
elasticity of the rubber. As a substitute for the rubber this 
bandage has the very desirable superiority of being highly 
porous, but its strength is considerably less. 

The rubber bandage, commonly known as the “Esmarch,” 
is made of gum rubber. It is used as a pressure or constrict¬ 
ing bandage for the arrest of hemorrhage. 

The starch bandage is merely crinoline which has been 
saturated with a boiled solution of starch, and rolled loosely 
after it has become dry. It is softened again in warm water 
for the application, and when it has dried in place it consti¬ 
tutes a fairly rigid and relatively light cast or splint. It 
will be used for the immobilization of fractured or otherwise 
injured parts. 

Plaster of Paris bandages are made of crinoline into 
which has been rubbed as much plaster of Paris as it will 
hold. They are applied wet and in numerous layers, and 
when they have dried they make a very rigid, strong, and 
heavy encasement or splint. They are used where complete 
immobilization of a part is needed, particularly for fractures. 

The nurse may need to make plaster of Paris bandages 


BANDAGES 


occasionally, and to do so she will proceed thus: Tear the 
crinoline the desired size (see below under “Sizes of Ban¬ 
dages”), and remove all ravelings; pour a large quantity 
of the plaster in a heap upon a smooth table; lay one end 
of the bandage upon this, brush a handful of plaster over 
it, rub firmly and smoothly with the hand two or three times 
and then roll the finished portion carefully and loosely. 
Proceed thus, rolling up each section of a few inches as fast 
as it is ready and handling very carefully so as not to undo 
what has been done. Substitutes for the hand, such as a 
wooden spatula, have been tried for rubbing in the plaster, 
but the hand is the best instrument in that it causes less 
friction and jarring and therefore produces a more smoothly 
and evenly impregnated bandage. Use plenty of plaster 
under your hand as you rub, brushing off the excess imme¬ 
diately before rolling the finished part. Wrap each bandage 
securely in paper as soon as finished. 

(b) Triangular Bandage. —Muslin is the usual material for 
this bandage, but any similar material will, of .course, serve 
as well. 

(c) Many-Tailed Bandage. —Muslin and Canton flannel 
will be used for this bandage, the choice depending upon 
the purpose it is to serve and the part to which it is applied. 


Sizes of Bandages 

(a) The Roller Bandage. —The length of the factory-rolled 
gauze bandage is usually io yards, and that of the muslin 
and flannel ones 5 yards. These have proved to be the most 
serviceable lengths on the whole, for these materials, the 
greater length being needed in the gauze because of its 
lighter weight and inferior strength which necessitate the 
use of more layers of it. The crinoline for the starch and 
plaster of Paris bandages may be of any length, but it is 
wise to vary the length with the width—that is, the narrower 
ones need not be as long as the wider ones. 

The width of the roller bandage will depend upon the 
part to which it is applied and will vary roughly as follows: 


Finger . M to 1 inch 

Hand and arm .i }4 to 2^ inches 

Foot and leg .1/4 to 3 inches 

.3 to 4 inches 

Body (chest and abdomen) .3 to 5 inches 


(b) The Triangular Bandage. —This bandage will vary 
in size with the part upon which it is used and will be in 
general as follows: 







BANDAGES 


Arm (the sling) .the half of i square yard 

Hand .the quarter of the sling 

Foot .the half of the sling 

Head ..the half of the sling 

Shoulder .*..the half of i square yard 

Hip .the half of i square yard 


Principles of Bandaging 

Before we undertake to apply a bandage we should adopt 
as our fixed, guiding influences these three principles of the 
art. 

1. Evenness of Pressure 

2. Durability 

3. Neatness 

Modes of Applying the Roller Bandage 

There are these five recognized modes of applying the 
roller bandage to the several parts of the body: 

1. Circular 

2. Spiral 

3. Reverse 

4. Figure-of -8 

5. Recurrent 

Each one of these modes has its reason for existence in 
some peculiar adaptability to a part, in a special suitability 
for some purpose, or in a combination of the two. Very 
few applied bandages, however, are pure examples of one 
mode, for the complexity of design in the human framework 
calls for a compound of two or more of them in the great 
majority of cases. 

First of all, the part to be bandaged is arranged in the 
position which is to be permanent for it; the bandager takes 
a position in front of the patient, as a' rule (exceptions 
will be discovered later); and the bandage is then disposed 
in the hands as illustrated—that is, one hand prepares 
to place and keep the free end where it belongs and the 
other to control the unwinding of the bandage as it is 
applied. We then study the five different modes thus: 1 

1 . Circular Mode.— The head is one of the subjects for 
this type of bandage and so, with both hands we lay the 
bandage against the forehead, a small portion having been 
unrolled for ease -in properly locating it. The free end is 
held against the temple with the one hand while with the 
other the bandage is rolled around the circumference of the 
head with even and firm tension till it reaches the free 
end when it is continued over this and around the head 










The way to grasp the roller bandage preparatory to apply¬ 
ing it. 

(From Colp and Keller’s Textbook of Surgical Nursing) 


The way to begin the application of the roller bandage. 
(From Colp and Keller’s Textbook of Surgical Nursing) 








BANDAGES 


again in exactly the same track. After the end has been 
secured the hand which held it will be released, of course, 
to assist the other one by carrying the roll around on its 
side of the head. When the roll reaches the location of the 
free end the second time we have a circle of two layers 
of bandage around the head, and have thus secured by 
friction and stress, or, in other words, have “anchored,” our 



The circular mode of bandaging—the usual anchorage for the 
applied roller bandage. 

(From Colp and Keller’s Textbook of Surgical Nursing) 

bandage; and at the same time we have applied the amount 
of bandage which may be taken as a standard foundation — 
that is, two layers. This will rarely ever constitute a com¬ 
plete piece of bandaging, but it does enter into nearly every 
bandage as the means of both anchoring it in the beginning 
and of securing it at the end. 

2 . Spiral Mode.—For this demonstration we shall select 
the upper arm. Grasp the bandage as before, lay it upon 




BANDAGES 


the arm near the elbow, and apply a circular bandage— 
that is, two layers, one directly upon the other, entirely 
around the arm. Then begin to travel upward with slow 
spiral turns of the bandage, allowing each turn to cover 
at least one-third of the width of the previously applied one. 
Keep in mind, as you do this, your three principles, main¬ 
taining the same tension on your bandage throughout, rolling 
the layers on smoothly and at a stable angle (that is, not 
so great an angle that they will have a tendency to creep 
back), and make it as neat as you can by keeping the edges 



The spiral mode of bandaging. 

(From Colp and Keller’s Textbook of Surgical Nursing) 

of every two layers parallel and by covering the same frac¬ 
tion of the width of the previous layer every time. Finished 
with two or more of the circular turns, this will make a 
complete design which is applicable only to such compara¬ 
tively parallel-sided parts as some upper arms, the fingers, 
etc., or to similarly-shaped splints. 

3 . Reverse Mode. —The forearm is a suitable part upon 
which to demonstrate this mode because of its cone-like 
outline. It will be a good plan for the beginner to apply, 
first of all, a few turns of the spiral bandage to this part 
in order to learn at once why it will not answer. She will 
see that it embodies an infraction of every one of the three 



BANDAGES 


principles of bandaging—that is, the two edges of the 
bandage exert unequal degrees of pressure, which is very- 
clear from the fact that one of them is entirely free of 
tension in a part of every turn; it will not stay in place, 
as its appearance very clearly indicates and as a slight pull 
would demonstrate; and it certainly does not look neat. We 
can correct all these evils very easily, however, in this way: 

Start just above the wrist with the now familiar circular 
bandage; then begin one of the spiral turns, but just as the 
lower edge of the bandage shows the objectionable slack, 
which is due to its having a shorter distance to cover than 
the other, turn the roller upside down, thus making a twist 
in the bandage which uses up this slack and allows the 
bandage to lie flat for the remainder of the turn, when 
the same problem will arise and it will be solved in the 
same way for each turn until the part is covered. In the 



B 


A 


The figure-of -8 mode of bandaging. A. the first turns; B, the 
completed bandage of the ankle. 

(From Colp and Keller’s Textbook of Surgical Nursing) 

act of twisting, or "reversing,” the bandage, special care 
is required to avoid stretching it so tightly that it will 
be drawn into wrinkles instead of into one flat fold. This 
is done by holding the applied bandage down with one hand 
just at the site of the reverse while the free part is allowed 
to slacken slightly for the moment of the reversal, after 
which the usual tension is resumed for the next turn. This 
bandage will be secured at the end with the usual circular 
bandage. 

A great deal of practice will be required before one can 
apply the bandage well by this mode, and if it cannot be 
done well some other mode should be used instead, for there 



BANDAGES 


are too many loopholes in it for offenses against all of the 
three principles of bandaging. It is a very suitable method, 
however, for tapering parts, such as the arm and leg, and if 
one wishes to become a versatile bandager she must learn it. 

4. Figure-of-8 Mode. —The ankle furnishes us with a good 
subject for this mode of bandaging. Start, as usual, with 



The recurrent mode of bandaging. The patient is holding 
the reverses in place at the back of the head. On a smaller 
part, such as the stump of a limb, the bandager can control 
the entire operation himself. 

(From Colp and Keller’s Textbook of Surgical Nursing) 


the circular bandage as your anchorage, placing it around 
the foot just at the base of the arch; then pass the bandage 
in figure-of-8 style thus: Diagonally across the instep toward 
the base of the heel, around the back of the heel, and 
across the instep again in the other diagonal to the original 
circular bandage on the side opposite the starting point of 
the first diagonal (A of Fig.). This completes one figure- 



BANDAGES 


of-8 turn, and the bandage is continued simply by repeating 
this maneuver till the part is covered, lapping each turn 
over one-third or one-half of the width of the preceding one. 
If this is to constitute a complete dressing it will be secured 
by the circular bandage around the ankle (B of Fig.). 

Though the design of this bandage is not the simplest 
one to learn, aside from that it is one of the easiest modes 
with which to secure good results under all of the three 
principles. Durability is an especially prominent feature 
of the figure-of-8 bandage, and its appearance can be made 
to compete very favorably with that of any of the other 
modes. 

The figure-of-8 design has a very wide application, being 
almost the only suitable one for the joints of the body. 



Completed recurrent bandage. Note that the turns all lie 
flat and that they converge toward the middle of the fore¬ 
head, which means that the reverses are lying directly over 
one another, as they should do. 

(From Colp and Keller’s Textbook of Surgical Nursing) 

particularly the larger ones, such as the ankle, knee, hip, 
wrist, elbow, and shoulder; and it is also applicable, in com¬ 
bination• with the reverse mode, in various other parts 
which will be indicated later. 

5. Recurrent Mode.—This is perhaps the most difficult 




BANDAGES 


mode to learn and it is also rather awkward to apply, in 
that it requires the assistance of a third hand when applied 
to the head, which is the most common subject for it. 
Often the patient himself will be able to lend this helping 
hand, but if he cannot do this an assistant must be provided. 
As it will probably be the only available part for practice, 
we shall select the head for our subject. Pass a circular 
bandage around the head, as described in Mode i, stopping 
at the middle of the forehead; then reverse the bandage 
by the same maneuver as you used for the reverse mode, and 
pass the roller backward across the middle of the head and 
down over the circular turn at the back, holding the fold of 
the reverse firmly in place with the thumb of the other 
hand meanwhile, and now asking the patient or the assistant 
to place his hand upon the intersection of the layers on 
the other side. Repeat this process, back and forth, till the 
whole head is covered, working from the middle toward the 
sides alternately, and covering one-half of the previous 
layer each time. In stationing the reverses it will be found 
possible and easiest to group them closely together (each 
immediately on top of the previous one) in the middle of 
either side rather than to distribute them along the circular 
bandage, as they can be more easily held in place this 
way and they will usually fit the part better thus. When 
the head has been entirely covered the bandage is again 
reversed to the direction of the original circular bandage 
and two more circular turns are passed around the head 
to secure the ends which you and your assistant have been 
holding. 

This makes a complete bandage which will often be used 
for the stump of a limb, the end of a finger, etc., as well 
as for the head. 


The Application of Bandages to Various Parts 
(a) The Roller Bandage 

Hand and Arm 

Either the spiral or the combination of the figure-of-8 and 
reverse modes will be found suitable for the fingers, with the 
introduction of the recurrent mode if the ends of the fingers 
are to be covered. As a rule, however, a finger bandage will 
not be durable unless it is connected with the wrist by means 
of a figure-of-8 and a circular bandage, introduced after 
every second or third spiral turn. Each finger may, of 
course, be bandaged in this way separately, but in everyday 
practice it will be found that when two or more fingers 
need bandaging they will usually be combined in one dressing 


BANDAGES 


and bandaged together, in which case the method for a 
single finger will apply. In cases where all the fingers 
are involved they will usually be combined in a single large 
dressing and the suitable mode of bandaging them will then 
be the recurrent one. The finger bandage may be anchored 
either around the wrist or the end of the finger. 



Spiral bandage of the finger anchored to the wrist with a 
figure-of-8 and a circular turn. 

(From Colp and Keller’s Textbook of Surgical Nursing) 

The thumb presents a somewhat different case from the 
fingers in that it is nearly always bandaged with what is 
termed the “spica” bandage. This spica involves nothing 
new as to mode, for it is a pure figure-of-8, but it so 



The thumb spica. 

(From Colp and Keller’s Textbook of Surgical Nursing) 

happens that in the complete design the layers present the 
appearance of the spikes in a head of barley, and therefore 
the bandage has been given the distinctive name “spica.” 
Though the term has its origin in the mere appearance of 
the completed bandage, “spica” always carries with it the 












BANDAGES 


meaning of a joint bandage because the figure-of-8 takes on 
this appearance in all cases of its application to a joint 
which connects an appendage to its trunk. 

Whether or not the fingers and the thumb are involved, 
our method of procedure for the hand and arm will be this: 



Complete bandage for the hand and arm. 



Reverse figure-of-8 bandage. A, front view showing the fig 
ure-of-8 turn; B, rear view showing the reverse turn. 
(From Colp and Keller’s Textbook of Surgical Nursing) 

Begin about the palm with the circular bandage, then a spiral 
or two if necessary, and proceed with the figure-of-8 over the 
back of the hand and the wrist, around the wrist with 
the circular, upward over the cylindrical part of the forearm 
with the spiral, and thence with the reverse over the conical 

















BANDAGES 


part to the elbow. The elbow (in a slightly flexed position) 
is then covered, directly over the joint, with two or three 
circular turns, several figure-of-8 turns (enough to cover it 
securely) are passed over this and about the joint, working 
upward and downward from the joint alternately. The 



/ 


Method for securing better anchorage of a bandage on a 
tapering part. The long spiral turns provide friction for the 
remainder of the bandage and also stabilize the wrist portion. 

(From Colp and Keller’s Textbook of Surgical Nursing) 

upper arm is then covered with either the spiral or the 
reverse, depending upon whether it is of a general cylindrical 
shape or a conical one. 

On the shafts of the arm a combination of the figure-of-8 
and the reverse modes is very suitable, the figure-of-8 being 
used as the theme and the reverse being introduced only 



3 


A 


Heel bandage. A, regular circular and figure-of-8 method; 
B, variation necessary for a prominent heel—an interlocked 
figure-of-8. 

(From Colp and Keller’s Textbook of Surgical Nursing) 

when needed to keep the bandage lying flat and to equalize 
the tension of the edges, which will usually be every second 
turn. In this case the cross of the figure-of-8 turn is made 
on the top of the arm and the reverse on the back. This 
bandage is very much preferred to any other by some persons 
because of its superior durability. 







BANDAGES 


Foot and Leg 

The toes may be bandaged separately, like the fingers; and 
when the figure-of-8 extension is necessary to keep it in place 
the ball of the foot will usually answer as the wrist does for 
the fingers. Also, as in the case of the fingers, when several 
or all of the toes are involved they will usually be dressed 
together and the bandage will be the recurrent one. 

When the heel is involved the principles of the elbow 
bandage may be applied to it—that is, after the circular 
turns have been applied around the arch of the foot a long 



(From Colp and Keller’s Textbook of Surgical Nursing) 

spiral turn of the bandage will carry it smoothly to the 
heel, a circular bandage is applied around the heel and the 
instep, and the figure-of-8 ankle bandage is then applied as 
in the case of the elbow. 

In cases where the heel is unusually prominent it will be 
impossible to cover it smoothly with the figure-of-8 bandage. 
This difficulty may be overcome by modifying the design 
for several turns as illustrated in B of Fig. An analysis of 
these turns will show that they constitute merely an inter¬ 
locked figure-of-8 passing crosswise of the ankle. 



BANDAGES 


In general principles the foot and leg bandage, as a whole, 
is exactly like that for the hand and arm. Disregarding the 
toes, we start around the arch of the foot with the circular 
turns, and one or two spirals if needed. Then cover the 
heel as described in the preceding paragraphs. This will 
entail the figure-of-8 of the ankle. The details for the 
remainder of the leg will then correspond exactly with 
those given for the arm, including the several variations 
pointed out there. 

The knee-joint bandage, of course, will be upside down 
from the standpoint of the bandager as compared with the 
elbow, but this will not cause any noteworthy confusion. 



(From Colp and Keller's Textbook of Surgical Nursing) 

The Eye 

The eye bandage becomes a very simple one if we conceive 
of it as being constructed, as it really is, entirely from the 
elementary circular bandage. Accordingly, let us imagine our 
standard circular bandage to be rigid, like a barrel hoop, and 
fit it thus into the several positions of the layers in the 

eye bandage. First of all, we place it around the top of 

the head as we did the circular bandage; this is our founda¬ 
tion, or anchorage. Then we imagine this circle on a pivot 

near the base of the nose and swing it down over the eye 

we are to bandage till it reaches the neck just below the 
ear on that side, and meanwhile, on the opposite side just 








BANDAGES 


over the other ear it will have risen somewhat above our 

foundation circle. The two circles will now cross each other 

on the forehead and on the back of the head. Then we 
swing our circle again but only far enough this time to 
cover one-half or one-third of the width of the parts of the 
other layers which lie below the one ear and above the 

other. In other words, this layer lies the width of the lap 

nearer each ear than the preceding one and crosses it on 
the forehead and on the back of the head at the sites of 
its intersections with the horizontal turn. This maneuver 
is repeated until we have enough angling layers (usually 
two or three) to cover the eye well, and then we swing our 
circle back again into the first position and apply one or 



Double eye bandage. 

(From Colp and Keller’s Textbook of Surgical Nursing) 

two of the horizontal turns to anchor the whole. On 
some heads it may be necessary to anchor each angling circle 
with the horizontal one, but this will mean merely swinging 
the circle alternately from one position to the other. 

The flexible bandage will not perform with all the mechani¬ 
cal exactitude of the rigid hoop, of course, and the changes 
in plane will have to be made with gradual sweeps, but 
these will be easily managed if the student has her picture 
of the hoop structure clearly in mind. 

To bandage both eyes all one needs to do is to alternate 
the angling turns between the two eyes, and as a rule one 
anchoring turn should be applied for each pair of angling 
ones. The whole is, of course, anchored finally with one 
or two of the horizontal turns. 

The Ear 

The ear bandage, for either one or both ears, will corre¬ 
spond to that for the eyes in all detail except that more 
turns will be necessary as a rule. In bandaging one ear 




BANDAGES 


it is sometimes difficult to avoid covering the opposite one 
also, but by careful planning this difficulty can practically 
always be overcome. 



The ear bandage. Note that it is merely the eye bandage 
design slipped about one-quarter of the way around the head, 
and that more turns are required for the ear region than 
were needed for the eye. 

(From Colp and Keller’s Textbook of Surgical Nursing) 

The Face and Jaw 

The Barton bandage of the jaw will be used in case of 
fracture where immobilization is desired. When analyzed 
this may be called a compound figure-of-8 bandage, for it is 
composed of two figure-of-8’s which have one loop in common 
—that is, the loop which envelops the crown of the head 
makes a figure-of-8 with either one of the two adjoining 




The Barton bandage. A, method of anchoring; B, the com¬ 
plete design. As this is usually a pressure bandage two or 
more layers will usually be necessary. The fastening of this 
bandage is not shown as it will be best placed on the head or 
face turn on the other side. . . 

(From Colp and Keller’s Textbook of Surgical Nursing) 



BANDAGES 


ones. To apply this bandage, begin by laying the end of the 
bandage diagonally across the top of the head, pass down¬ 
ward across one cheek, underneath the chin, upward over the 



Two methods of bandaging the cheek, temple, or chin. A, 
a simple figure-of-8 which will fit a head with a prominent 
crown; B, method necessary when the crown of the head is 
flatter, the turns about the forehead alternating with the 
others and binding them in place. Bandage A is fastened on 
the other side of the head. 

(From Colp and Keller’s Textbook of Surgical Nursing) 


other cheek, across the head in the other diagonal (A of 
Fig.), downward and around the back of the head, forward 
around the front of the chin, thence to the back of the head, 
and then upward to the starting point at the top of the 
head. This is the complete design of the bandage (B of 
Fig.), but as it is usually applied for pressure upon the 
jaw one or two layers more will be added. This bandage 
will usually be applied under considerable tension. 

The illustrations show tzvo ways of applying a bandage to 
the cheek, temple, or chin. They need no special explanation 
except that they are started like the Barton bandage. Since 
heads vary so much in shape a trial must always be made 
of the first turn of these bandages to make sure that it is 
stably stationed. A variation forward or backward, on the 
top of the head, of the starting point, will always enable 
one to find the proper balance. 


The Head 

The appropriate bandage for the head is the recurrent one. 

A more convenient way to apply the head bandage, however, 
is with tzvo roller bandages, the ends of which have been 
carefully pinned or sewed together. For this we proceed 
thus: Lay the bandages against the middle of the forehead, 






BANDAGES 

and then hold one stationary while you apply the anchoring 
circular bandage about the head with the other. Then pass 
the bandage which has been idle across the top of the head 



Double roller bandage for the application of the recurrent 

bandage. 

(From Colp and Keller’s Textbook of Surgical Nursing) 



The way to use the double roller bandage. 

(From Colp and Keller’s Textbook of Surgical Nursing) 


to the circular turn at the back, roll the other bandage 
across this (Fig.), and then continue carrying the one 
bandage back and forth over the top of the head and binding 
it down at each end by the circular turns of the other. 












BANDAGES 

The whole head may, of course, need to be covered thus, 
but the student should form the habit (which does not seem 
natural for beginners) of putting on only as much of the 
head bandage as is necessary to keep the dressing in place, 
as it is very easily discontinued at any point. 

The Shoulder and Axilla 

The “spica” is the bandage most frequently used for -the 
shoulder. Like the thumb spica, of course, it is merely a 
figure-of-8 design, and needs no comment except, perhaps, 



The spica bandage of the shoulder. 

(From Colp and Keller’s Textbook of Surgical Nursing) 

to point out that the application of it is begun about the 
arm, and that a few spiral or reverse turns should be made 
around the arm for secure anchorage before beginning the 
spica proper. 

When there is a dressing in the axilla to be covered the 
shoulder spica may be varied by alternating turns around the 
chest with the figure-of-8 turns. 

The Velpeau bandage will be used to immobilize the 
shoulder in such cases as fracture of the clavicle or scapula 
or dislocation of the shoulder. Place the arm of the injured 
side across the chest so that the hand lies well up toward 
the other shoulder. Start the bandage by placing the end 



BANDAGES 


over the scapula of the sound side, carry the roller forward 
over the injured shoulder, angling downward and under¬ 
neath the humerus, and thence forward over the anterior 
chest and around to the starting point (A of Fig.). 



The shoulder spica bandage varied to cover the axillary 

region. 

(From Colp and Keller’s Textbook of Surgical Nursing) 



The Velpeau bandage. A, the first turns, two or more lay¬ 
ers being necessary, as a rule, in the turn about the humerus; 
B, the completed Velpeau. 

(From Colp and Keller’s Textbook of Surgical Nursing) 














BANDAGES 


Repeat this turn once for security and strength, then make 
a circular turn around the chest and over the arm just at 
the elbow, and then complete the bandage by alternating these 
two turns till the whole arm has been covered (B of Fig.). 

The Breast 

This bandage is another figure-of-8, one loop of the 
figure passing horizontally about the chest and the other 
diagonally between the affected side and the opposite 
shoulder (A of Fig.). 

Start underneath the arm of the affected side and anchor 
the bandage with two circular turns about the chest just 



(From Colp and Keller’s Textbook of Surgical Nursing) 



The double breast bandage. 

(From Colp and Keller’s Textbook of Surgical Nursing) 













BANDAGES 


beneath the breast, passing the roller across the anterior 
chest first and then around the back—that is, when the right 
breast is to be bandaged the end of the bandage is placed 
under the right arm and the roller is carried across the 
anterior chest to the left arm; and for the left breast the 
direction is reversed. The anchorage completed, the first 
diagonal turn is started directly underneath the breast, and 
is carried well over on the opposite shoulder, thence angling 
downward across the back and around to the starting point. 
These alternate horizontal and diagonal turns are then 
repeated till the whole breast is covered (B of Fig.). 

To bandage both breasts at the same time, start as for 
one. Apply the first diagonal turn, start the next horizontal 
turn but carry it only as far as the opposite side and then 
instead of completing it carry it diagonally upward across 
the back to the other shoulder, and thence diagonally down¬ 
ward across the anterior chest and underneath the other 
breast. Then apply a complete circular turn and extend 
it around to the starting point under the first breast. Con¬ 
tinue the bandage by alternating the diagonal maneuvers 
with the horizontal one till the breasts are covered. 

Hip Spica 

There is no essential difference between this bandage and 
the spica of the thumb. The hip spica is sometimes applied 




The hip spica bandage. A, without the circular turn about 
the waist; B, with the circular turn alternating with each 
figure-of-8; C, the double spica applied with a single bandage. 
(From Colp and Keller’s Textbook of Surgical Nursing) 











BANDAGES 


without the circular turns about the waist (A of Fig.), but 
the alternation of the circular turn with each figure-of-8 (B 
of Fig.) makes a more durable bandage and one which 
will be more comfortable for most patients. Any part of 
the hip region may be covered with this bandage by simply 
placing the spica directly over the wound. This bandage 
may be started around either the waist or the leg. 

A double hip spica is very readily applied with one bandage 
by simply alternating the figure-of-8’s between the sides and 
inserting circular turns about the waist between them each 
time (C of Fig.). This bandage may be started around 
either the waist or one leg. 

For the application of these bandages it will be necessary 
to elevate the patient’s hips on a rest. 

(b) The Triangular Bandage 

As remarked previously, the triangular form of bandage, 
with one or two exceptions (chiefly the sling), is an 



Various applications of the triangular bandage. 

(From Colp and Keller’s Textbook of Surgical Nursing) 

emergency one and will be used only in the absence of the 
roller bandage. Emergencies, however, are very important 
and the nurse should, therefore, not consider her bandaging 
education complete till she has become adept with the 
triangular bandage. Parts to which this bandage may be 
applied are the arm (sling), hand, head, foot, shoulder, hip. 












BANDAGES 


etc., and the illustrations will give all the suggestions she 
will need for the several cases. 

The three principles of bandaging are, of course, as 
applicable to this form of bandage as to the roller one. 

(c) The Many-Tailed Bandages 
The student’s first concern as to these bandages is to make 
them of the proper size, because they must fit well if they 
are to be faithful to our three bandaging principles. Parts 



Various applications of the many-tailed bandages. 
(From Colp and Keller’s Textbook of Surgical Nursing) 


to which the several types are applicable are the head, 
chin, breast, abdomen, arm, leg, etc., and the illustrations 
will show the variations suitable to these different parts. 

Miscellaneous Special Bandages 
The plaster of Paris bandage is a roller bandage, but as 
it is applied wet and eventually becomes very rigid its 
application involves a few points which differentiate it from 
the average roller bandage. First of all, the plaster is never 
placed directly upon the skin, a substantial padding of 
cotton, Canton flannel, • or stockinet, etc., always being 
used underneath it. The nurse will r arely ever apply 

this bandage herself but she will assist with it and her part 
will doubtless be the soaking of it. This she will do by 


















BANDAGES 


standing it on end in a basin of sufficient warm water or 
weak salt solution to cover it. A very few moments will 
suffice for saturating it, the cessation of the bubbling which 
always follows immersion indicating that it is ready for 
use. Since you have probably made the bandage yourself 
you will know how insecure the plaster is within it and 
will therefore be very cautious about the removal of it from 
the water. It must be squeezed just enough so that the 
water will no longer drip from it—no more and no less— 
for if too wet the dripping water will carry the plaster away 
with it and will unnecessarily wet the padding, and if too 
dry it will become hard before it can be applied. Your 
method, therefore, will be to encircle the bandage very 
cautiously with a hand at either end, compress the ends gently 
at the same time, lift it out of the water, and simultaneously 
extend your pressure over the remaining surface just suffi¬ 
ciently to stop the dripping—but do not twist it. Practice 
is required to do this well and without wastage of the 
bandages, for it must be done quickly as well as carefully. 
As light wood splints are sometimes used to reinforce this 
bandage they will be part of the nurse’s preparation, as 
will also a small amount of dry plaster which is sometimes 
used for finishing the surface of it. 

For the application of the starch bandage the nurse’s 
preparation will be similar to that for the plaster, but the 
bandages will not require the extreme care in handling and 
they may be more nearly freed of the water. 

The Esmarch bandage is sometimes applied for the purpose 
of reducing the venous circulation of a congested part and 
thereby increasing its arterial supply and the accompanying 
local nourishment. This constitutes a special treatment 
known as the “Bier’s” treatment. It will, therefore, never 
be administered except by special order, but it belongs to the 
subject of bandaging and there are several points about it 
which the nurse should learn. 

The treatment is usually administered to some inflamed 
part of the extremities, and the general rule of applying the 
bandage from below upward will hold in this case. The 
mode of application will be the spiral one; the bandage 
will be applied above the inflamed part; and as the object 
of the bandage will be to restrict the venous circulation and 
not the arterial, it must not be applied too tightly. The 
frequency and duration of this treatment will be prescribed, 
and while it is in operation the nursing attention must be 
faithful. The parts below the bandage should retain their 
normal temperature; there should be no accompanying 
pain; the pulse in the part should not be altered; but a 
moderate amount of swelling and edema, and a bluish-red 


BANDAGES 


color, should be expected. As a rule, the part will be 
elevated after the bandage has been removed to hasten the 
reduction of the edema, but the nurse will be guided by- 
instructions from the surgeon as to this. 

Varicose veins of the leg are sometimes treated with a 
pressure bandage. The material to be used for this bandage 
Vvill usually be prescribed, and it may be any one of those 
we have already discussed. The elastic materials, however, 
will probably be given preference, though where elasticity is 
desired it may be secured in some degree with an inelastic 
bandage by first covering the part with a thin layer of non¬ 
absorbent cotton. The importance of this bandage from 
our present standpoint lies in the requirements that it be 
very smoothly and evenly applied, that its tension be sufficient 
to support the enlarged veins without obliterating them, 
and that it be applied as follows: Elevate the foot somewhat 
before applying the bandage so that the veins will not be 
unnecessarily engorged; start the bandage near the toes; 
and use the spiral form as much as possible throughout, 
departing from it only sufficiently to secure even pressure 
over the more irregularly shaped parts. 

A pressure bandage is sometimes applied to the extremities, 
particularly the legs, in case of shock to reduce the circula¬ 
tion in them to some degree and thereby to conserve the 
heart’s energy somewhat. A generous layer of non-absorb¬ 
ent cotton should always be used under this bandage be¬ 
cause, while it furnishes the usually desired elasticity it 
also conserves the body heat which is vitally important in 
such cases. 


The Fastening of the Bandage 
(a) The Roller Bandage 

First of all, the site selected for the securing of the end of 
the bandage should be remote enough from the wound to 
avoid causing pain to the patient by the manipulation nec¬ 
essary. If not inconsistent with this point, an accessible 
place should be chosen for evident reasons. And of not 
the least importance is the point that all fastenings that pro¬ 
trude, such as knots and safety pins, should be so placed that 
the patient will not have the discomfort of resting upon them. 

There are four good methods for fastening the bandage 
and they have their special adaptations and limitations as 
follows: 

1. Safety Pin. —This will apply to most bandages and it is 
a very satisfactory one because it can be passed through all 
the underlying layers and so bind them all securely together. 
It may sometimes be objectionable, however, for children in 




D 

Methods of fastening the roller bandage. A, the corners 
of the end are turned under and a safety pin passed through 
it and some of the underlying layers; B, the corners of the 
end are turned under and a strip of adhesive plaster binds it 
to the layer underneath; C, the end of the bandage has been 
split lengthwise far enough to make two tails long enough to 
be tied around the part, a knot being tied at the bottom of 
the slit to prevent further tearing; D, the corners of the end 
are turned under and a few stitches taken between it and the 
underlying layer. (From Colp and Keller.) 















BANDAGES 


places where they can reach it and open it, or where they 
might injure themselves upon it. Likewise, irrational pa¬ 
tients are liable to interfere with this fastener. 

2. Adhesive Plaster. —This is unobtrusive and neat but it 
is not as secure as the safety pin and will not, therefore, 
answer for some pressure bandages. Also, it cannot be 
used for a bandage over a wet dressing nor in any other 
case where the bandage is likely to become wet, as in the 
instance of the Carrel-Dakin treatment. 

3. Tying. —This is a rough-and-ready method which can 
always be resorted to in the absence of other means. To 
fasten the bandage by this method, tear or cut it down the 
middle of the end, tie a knot at the bottom of the slit to 
prevent further tearing, and then tie these strips around 
the part. The student should learn this method but she 
should immediately store it away for emergency use only, 
as it is almost never comfortable to the patient because of 
the fact that if it is tight enough to hold the bandage in 
place it will cause a line of stricture. 

The Esmarch bandage is an exception to this case in that 
eying is about the only suitable method for it. The rubber 
will not, of course, be split to make the strings, for tapes are 
usually cemented to one end for the purpose. If these are 
lacking, however, a few turns of a gauze bandage, a piece of 
tape, or anything similar may be fastened about the terminus 
of the Esmarch. The above-mentioned objection to tying 
does not enter into this case because the rubber is rigid 
enough to dissipate the objectionable pressure of the string. 

4. Sewing. —This method is applicable where greater 
strength is needed, or in the case of children or irrational 
patients. It goes without saying, of course, that great cau¬ 
tion is necessary in sewing a bandage on a patient. 

(b) The Triangular Bandage 

The safety pin, tying of the corners, or both, will cover 
all cases for this bandage. 

(c) The Many-Tailed Bandages 

Tying of the ends or safety pins will answer for the head 
and chin bandages, but for the other parts safety pins are 
all but indispensable. 

Miscellaneous Bandaging Rules 

i. Never bandage two surfaces of skin together —separate 
them with gauze or cotton, preferably non-absorbent cotton. 
There is always a certain amount of moisture present on 
the surface of the skin and if this is confined it will accumu¬ 
late, and in addition to being uncomfortable it may seriously 
chafe the parts in time. The non-absorbent cotton keeps these 


BANDAGES 


surfaces apart and allows evaporation of the moisture, whereas 
absorbent cotton or gauze absorbs and retains it. This 
applies particularly to the fingers, toes, axilla, and the arm 
and chest in the case of the Velpeau bandage. 

2. In all cases where surgical necessity does not con¬ 
travene, parts should be bandaged in their accustomed posi¬ 
tion. This applies with special emphasis to the ears, which 
should always have sufficient padding behind them to prevent 
their being held more closely to the head than is natural 
for them. Bandages of the neck, axilla, the hand and 
fingers, and the toes, also call for special consideration in 
this respect. 

3. In bandaging the hand and foot leave the Ungers and 
toes exposed if possible so that they may be watched as 
guides to the condition of the circulation of the limb. 
Coldness, blueness, and swelling of the fingers or toes, 
or of any part below a bandage, are signs that it is too 
tight at some point. This accident is very largely precluded 
by attention to pressure in the application of the. bandage, but 
it must not be forgotten that parts under even the most 
expertly applied bandage may swell later from causes entirely 
unrelated to the bandage itself. In the cases of the arm 
or leg the pulse, if accessible, at the radius or the dorsum 
of the foot will, of course, be a valuable guide to the state 
of the arterial circulation. 

4. Do not apply a wet bandage because it will probably 
shrink in drying and become too tight. The plaster of Paris 
and starch bandages are, of course, exceptions, but they are 
always applied with this in mind, and a thick padding of 
stockinet, cotton, or Canton flannel is usually provided under¬ 
neath them to guard against this danger. 

5. When applying a bandage over a wet dressing, or over 
a Carrel-Dakin dressing which will eventually become wet, 
remember this probability of shrinkage and apply it corre¬ 
spondingly loosely. 

6. If necessary to bandage a dressing under a splint, re¬ 
member to do it loosely because, even though you may be able 
to note the condition of the part, it will be very incon¬ 
venient to correct undue tightness in this case, and dura¬ 
bility is not important here since the splint and its bandage 
will give the additional security needed. 

7. In placing the reverses of the reverse bandage, see that 
they are not over bony or prominent parts, such as the shin 
or radius, for they may become very painful because of the 
uneven surface they create. The line of these reverses is 
best placed on the outside of the leg and arm. 

8. Always apply the roller bandage from beloiv upward, 
particularly when exerting special pressure, because when put 


BANDAGES 


on in the opposite direction it allows the veins, which are 
eventually to be underneath it, to become engorged with 
blood which is thus imprisoned and may later be the cause 
of much discomfort and even more far-reaching trouble. 
Likewise, the Scultetus bandage should be fastened from 
below upward. 

9. Make it a rule in applying the roller bandage to the ex¬ 
tremities to start by rolling it outward rather than inward— 
that is, to bandage a right arm or leg (assuming that you are 
face-to-face with your patient), hold the roller in your left 
hand and start by rolling it toward your left side; to bandage 
a left arm or leg, then, you will hold the bandage in your 
right hand and start it toward your right. A test applica¬ 
tion will show you that observance of this rule will give 
you greater freedom and ease in the adjustment of the re¬ 
verses and the figure-of-8’s. 

The Removal of Roller Bandages 

Game and paper bandages are rarely ever used more than 
once and they are therefore usually cut away. If one is 



Instruments for the removal of plaster of Paris bandages— 
saw, knife, and heavy bandage scissors. 

(From Colp and Keller’s Textbook of Surgical Nursing) 

equipped with the special bandage scissors, the operation is 
very simple, as the blunt point can be passed underneath the 
bandage with perfect safety, provided, of course, that the 










BANDAGES 

region of the wound is entirely avoided, as it should be in 
any case. 

The washable and rubber bandages will simply be un¬ 
wound, and a little practice will enable one to roll them 
together loosely as fast as they are unwound. Dexterity in 
this is really a valuable acquisition because it saves much 
time and avoids annoyance to the patient and confusion to 
the bandager. 

For the removal of plaster of Paris bandages one needs a 
strong knife or saw and a pair of strong bandage scissors. 
There are special instruments made for this purpose and 
they will usually be provided in hospitals. The operation 
consists merely in cutting directly through the entire length 
of the shell in a sufficient number of places to enable 
one to lift the cast away with as little disturbance as pos¬ 
sible to the patient. The lines chosen must be accessible, of 



Bandage scissors. The one longer point is blunt and 
smooth and is designed to be passed underneath a bandage 
immediately on the surface of the patient’s body without 
danger of injury during the process of cutting off the band¬ 
age—a procedure which is never safe with an ordinary pair 
of scissors. 

(From Colp and Keller’s Textbook of Surgical Nursing) 

course; if possible they should be remote from the wound 
(if there is one); and to save labor one should select the 
shortest lines that will answer the purpose. Some labor 
may be saved in the sawing process by wetting the plaster 
immediately ahead of the instrument with a few drops of 
hydrogen peroxide, acetic acid, or bichloride solution. These 
solutions have a slightly solvent power over the plaster, 
but a little plain water answers the purpose very well also. 
Care should be taken not to use enough of these solutions to 
wet bandages or dressings underneath, and it should also 
be remembered that the bichloride will be very unkind 
to the metal instruments if exposed to them too long. The 
precaution should always be taken of discarding the knife 
or saw in favor of the scissors before this bandage is en- 




BATHS 


tirely severed, to escape the danger of cutting the patient. 
Sometimes this labor will be obviated by the surgeon who 
will cut the plaster just after applying it and while it is 
still soft. In this case the cast will be bound together by a 
strong bandage and its removal will then be a simple mat¬ 
ter. 

Starch bandages can usually be cut with strong bandage 
scissors, though if they are thick the plaster knife or saw 
may be needed. 

BASHAM’S MIXTURE 

See Iron. 


BATHS 

Bathing. —Baths are given for various effects and at 
different temperatures, but the fundamental reason is to 
stimulate the action of the skin, so that it can perform its 
various functions. By bathing—the blood circulation of 
the skin is stimulated—the temperature of the body is kept 
even—and the residue of the oily substance, with the waste 
matter which is brought to the surface by perspiration is 
removed. In most conditions a bath is refreshing to the 
patient and soothing to the nerves. 


Temperatures of baths. 

Hot bath . 

Warm bath . 

Tepid bath . 

Cool bath . 

Cold bath . 


104-1io° F. 
90-100° F. 
80- 90° F. 
70- 8o° F. 
60- 70° F. 


Cool or cold baths are given for their tonic effect and 
also to reduce temperature. A patient should be rubbed 
constantly during such a bath to bring more blood to the 
surface to have it cooled. 

Hot baths are sometimes ordered for special reasons: to 
cause excessive action of the skin, to relax muscles or to 
stimulate the heat of the body. Hot baths taken continually 
are enervating. 

A warm bath with a non-irritating soap is the usual bath 
for cleansing purposes. This sometimes may be followed 
by a coW sponge to act as a tonic for the skin. 

Soda, bran and starch baths are used to allay irritation 
of the skin and are given warm or tepid. 

A soda bath is prepared in the proportion of 8 ounces 
of bicarbonate of soda (ordinary baking soda) to every 
gallon of water. In this case the patient should be care¬ 
fully dried without rubbing to avoid irritating the skin. 

A bran bath is prepared an hour beforehand by placing 







BATHS 


two pounds of bran in a bag (cheesecloth or some other 
thin material) and allowing it to soak in a tub half full 
of water, and squeezing the bag often. Hot water may be 
added immediately before the bath. 

A starch bath is prepared thus: mix about 8 ounces of 
starch in a little cold water. Add sufficient boiling water 
to make a very thin paste and mix this with the bath water. 

Salt baths are given for their tonic effect on the skin. 
Allow 2 or 3 pounds of salt to a tub half full of water, dis¬ 
solved in hot water and then cooled to the desired tempera¬ 
ture, which is usually cool or cold, although sometimes 
ordered quite warm. 

General Rules for Bathing 

The ideal times for bathing are in the morning or at 
night. 

Baths should not be given sooner than to 2 hours 

after eating as, by thus increasing the circulation of the 
skin, blood is brought from the stomach where.it is needed 
during the process of digesting the food. 

The room in which a bath is taken should be warmer 
than usual and without draughts. 

Everything needed should be ready before beginning the 
bath. 

Tub Bath 

Uses. 

For cleanliness 
To increase temperature 
To decrease temperature 
To relax the muscles 
To soothe the nerves 

Articles needed. 

Chair Soap Wash cloths 

Bath mat i face towel Personal linen 

2 towels, warmed 

Method. —The room should be warm and without draughts. 
Place a chair conveniently near with a towel spread on 
it and a mat on the floor beside the tub. Fill the tub half 
full of water at a temperature of 90° or, if desired, the 
bath can be made warmer. Help the patient both in getting 
in and out of the tub. Use plenty of castile soap and a 
rough wash cloth. Rinse the skin well and, when drying, 
rub briskly with a warmed towel to increase the circulation. 
Have the patient rest for at least an hour afterwards. When 
a patient is taking her own bath, always stay within call 
in case your assistance is needed. 


BATHS 


Sponge Bath in Bed 

Uses. 

For cleanliness. 

To keep the pores of the skin open. 

To give comfort to patient. 

To remove waste material given off through the skin. 


Articles needed. 

2 basins 

1 face towel 

2 bath towels 
2 wash cloths 

Personal 


Small blankets 
Soap 
Alcohol 
Powder 
and bed linen 


Method. —Half fill one basin with water at a tempera¬ 
ture of no° and the other with cooler water for rinsing. 

Draw patient toward the edge of the bed. Remove the 
pillow entirely (to rest the muscles of the neck) or replace 
it with a smaller pillow if the patient prefers. 

Lay a small blanket, arranged in three folds, across the 
chest and have the upper end of it held by the patient or 
tucked in around the shoulders so that while folding down 
the bedclothes to the foot of the bed, the other end of the 
blanket may be drawn with it, thus covering the patient. 
Then place another small blanket lengthwise on the bed, 
rolled close to the patient’s side. Draw this beneath the 
body and remove the nightdress under cover. 

Each part is washed, rinsed and dried separately and the 
body is at all times protected by a cover blanket. 

In using a wash cloth, take all four corners within the 
hand to prevent them dripping on the patient, and wash 

with firm, gentle stroke. First bathe the face, wiping the 
eyes toward the nose. Then the neck and ears. Then 

bathe the arms and immerse the hands in the water and 
carefully clean them, using a brush and an orange stick 
for the nails, and when bathed wrap the arms in folds of 
the under blanket. Then proceed to bathe the chest, axillae 
and abdomen. After drying them, turn the patient on the 
side and wash to the waist line, then to the middle of 

the thigh, and dry. Turn the patient again on the back 
and wash the legs, which can more easily be done by flexing 
the knees. Place the feet in the basin of water when 
bathing them and use a brush for the nails. Wash the 

soles of the feet with firm, steady strokes to prevent tick¬ 
ling and carefully bathe the pubic region unless this has 
been done prior to the whole bath. 

If alcohol is used, rub it on each part after it is dried. 
Powder if desired. 


BATHS 


When the bath is finished, remove the under blanket, re¬ 
place the nightdress, draw up the bed clothes, and remove 
the cover blankets. Replace the pillows which have been 
shaken up and if the bedding requires to be changed, this 
should be done at the same time that the under blanket is 
removed. 

In case only one bath blanket can be procured, use it 
doubled or substitute turkish towels. 

Cold Alcohol Sponge Bath 

Uses. —To reduce temperature. 

Articles needed. 

1 basin of cold water i hot water bag 

2 large wash cloths of rough 3 safety pins 

material 1 bottle alcohol, 95 per cent. 

3 towels Ice bag or cloth for head 

Ice (if ordered) 

Mix alcohol and water in equal parts. 

Method. —Prepare the bedding and the patient as for a 
sponge bath, except for these details: a rubber sheet should 
be put beneath the under blanket so that more water may 
be safely used, and a loin cloth is pinned about the hips. 
Allow the head to remain slightly raised. 

Apply an ice bag to the head, or a cloth wrung out of 
cold water and frequently changed. Then remove the 
upper blanket. Proceed to bathe the large surfaces of the 
body, keeping up friction which, by constant rubbing, 
brings the blood to the surface of the body to be cooled. 
Let the water evaporate; do not dry it off. The only part 
which cannot be vigorously rubbed is the abdomen or any 
tender spot. 

Half the time ordered for the bath (usually 15 or 20 
minutes) is given to sponging the front of the body; the 
remainder is spent on the back with the patient turned on 
her side. 

To remove the patient from the bath.—Remove the 
cold application from the head. Place a blanket over the 
body and remove loin cloth and under blanket by rolling 
them close to the patient’s side and slip another blanket in 
their place at the same time. Turn the patient on to it. 
Draw up the upper bedding and place a hot water bag 
near the feet. Give hot broth to drink and at the end of 
half an hour remove the blankets and hot water bag, re¬ 
place the nightgown and take the temperature, pulse and 
respiration. 


BEDBUGS 


Foot Bath 


Uses—in general. 

To relieve congestion, by increasing general circulation. 
To draw blood away from the head. 

Articles needed. 


Foot tub and water 
i rubber sheet 
3 towels 
i blanket 


Pitcher with additional hot 


water 

Hot water bag with cover 
Bath thermometer 


Mustard 


Foot bath for patient in sitting position. —Patient should 
recline in a comfortable chair. The bath is prepared in a 
foot tub at a temperature of 105°. Place the rubber 
sheet on the floor to protect the rug; fold the blanket in 
half, placing one end under the knees so that the patient 
is sitting on it. Then move the tub in position, having 
a thermometer in the water or testing heat with your elbow. 
Lower the feet gently into the water and cover with the 
other end of the blanket, lifting one corner occasionally 
to add hot water. This should be done gradually until the 
temperature reaches no°. When mustard is added (one 
tablespoonful to a gallon of water) a lubricant should be 
applied to the soles of the feet to prevent irritation. 

When finished, withdraw the tub, dry the feet and leave 
them wrapped in a blanket or apply a hot water bag for 
a few minutes. 

Note. —Mustard should be mixed to a thin paste in cold 
water and thoroughly stirred into the bath. 

Foot batb in bed. —Flex the patient’s knees and turn 
the bed clothes back from the foot of the bed over them; 
lay the extra blanket into a simple envelope or fold, one 
side of which rests on the bed under the tub while the 
other is drawn up over the legs and tub. Continue the 
bath as described above. It will be found more convenient 
to let the tub lie lengthwise on the bed, with the edges 
covered by a folded towel to protect the legs from touching 
the edge. 


BEARBERRY 


See Uva Ursi. 


BED IN LABOR 


See Labor, Management of. 


BEDBUGS 


See Lice. 


BED-MAKING 


BED-MAKING 

A closed bed. —In making a bed see that it has been freshly- 
aired and that the mattress is turned. A light pad or 
blanket should be provided to protect the mattress. Over 
this should be spread the under sheet, the wide hem to the 
top and a greater surplus left to tuck in at the head than 
at the foot of the bed. Tuck the sheet in first at the head 
of the bed, then at the foot of the bed and then down one 
side; going to the other side of the bed, pull the sheet 
snugly across, tucking it in firmly and seeing that the cor¬ 
ners are neatly squared. 

All sheets and blankets must be placed with the center 
fold to the center of the bed so that they will not wrinkle 
when stretched to be made tight. 

If it is necessary to protect the mattress, a rubber sheet 
may be placed over the under sheet and tucked in at both 
sides before the draw-sheet is spread. 

The draw-sheet is tucked in firmly on one side, then 
stretched and tucked in on the other. If a double sheet is 
used for this purpose, the fold must be towards the top of 
the bed. 

The upper sheet should be placed with the wide hem at 
the top, right side down so that when the sheet is turned 
back over the bedding the smooth side of the hem will be 
uppermost. The edge should just reach the top of the 
mattress, leaving the remainder to be tucked in at the 
foot. The lower corners should then be squared and 
tucked in. 

Each blanket is put on like the top sheet, but not nearer 
than 12 to 14 inches to the head of the bed. When the 
blankets are adjusted, the top sheet is turned back over 
them and tucked in down the sides loosely. Over all is 
laid a light spread stretched evenly to the top x>f the mat¬ 
tress and tucked in firmly at the foot, with the corners 
mitered or squared and the sides left hanging. 

Pillows should be shaken well down into their corners 
then flattened out and placed in position; one across the 
bed and the other standing up on it, folding any surplus 
pillow slip well out of the way. 

An opened bed—ready for use. —To prepare a bed for a 
patient: (1) slip one hand under the mattress and raise 
it slightly while pulling the upper bedclothes out with the 
other. Loosen the bedding in this manner from both sides 
of the bed. (2) Fold the spread under the top of the 
blanket and then fold the upper sheet down over this. 
(3) Then, facing the foot of the bed, fold the clothes back 
in parallel plaits across the bed to its foot, where they re- 


BED-MAKING 


main until needed to be drawn up over the patient. The 
pillows are arranged one on top of another. 

To Change Bedding with Patient in Bed 

To replace the upper sheet only.- —Spread the clean sheet 
across the bed after removing all but one blanket and the 
soiled top sheet. These may be drawn away under the new 
covering and the outer bedding replaced and tucked snugly 
in at the foot and sides with the corners carefully squared. 

Sheets are more often changed than blankets in making 
a bed fresh so that ordinarily the spread and top blanket 
may be completely removed while the change is being 
made. 

To remove top bedding. —When necessary for any pur¬ 
pose to do this, place a folded light blanket over patient’s 
chest, loosen the bedding at the foot and fold it back as 
far as the patient’s knees; the bedding at the top is then 
turned down over this in one deep fold, drawing the blanket 
with it, then the sides one after another are folded over 
making a square. This can be readily removed and replaced, 
unfolding the square in the same manner. 

To change the under sheet. —Remove the upper bed¬ 
clothes as described. Then, steadying the mattress with 
one hand so that the patient is not disturbed, loosen the 
under sheet and the draw-sheet. Draw or turn the patient 
to one side of the bed and fold back the soiled lower sheet 
close to the body. Then spread the clean sheet smoothly 
over the side of the mattress which is clear, leaving the 
greater length at the top and taking care that the center 
fold of the sheet is in the center of the bed. Tuck in 
tightly at the head and the foot, then along the side. Put 
the draw-sheet in place and tuck in on the side, bringing 
the rest of it with the surplus of the lower sheet close to 
the patient’s body; then go to the other side of bed and 
turn the patient away from you on to the clean sheet. 
Remove the soiled ones and spread the remainder of the 
clean sheets over the mattress, tucking them in securely 
under the remaining sides and ends. 

If a patient cannot well be turned, the knees may be 
flexed and the lower bedding drawn under the body at the 
hips, after which the shoulders and legs may be alternately 
raised while the bedding is made smooth underneath. 

To change a draw-sheet. —Fold the upper bedding back 
a little, loosen the soiled draw-sheet, folding it closely to 
the patient’s side. Replace this with a fresh draw-sheet, 
tucking it in on the side nearest you and spreading the 
rest smoothly. Turn the patient back on this fresh sheet 


BED-MAKING 


and remove the soiled one, drawing the remaining half of 
the clean sheet across the bed and tucking it in securely. 

The chief advantage of a draw-sheet, aside from the 
protection it affords the bed, is the ease with which it can 
be changed. 

To change a draw-sheet when a rubber sheet is used, 

fold, spread over the bed and tuck in both together. 

To change bedding when only one rubber sheet is avail¬ 
able. —Loosen bedding on one side, fold draw sheet close to 
patient’s side, lay rubber sheet back up over the patient’s 
body, then fold lower sheet close to patient’s side and 
spread the clean under sheet. Bring down the rubber, 
lay in clean draw-sheet and tuck it in, turn patient over, 
remove soiled draw-sheet, lay rubber back over patient’s 
body, remove soiled under sheet. Draw over and tuck in 
the clean one. Bring down rubber and spread the clean 
draw-sheet and tuck them in together. 

In folding sheet in lengthwise plaits, as frequently 
directed, divide it into an uneven number of folds with 
the free edge topmost and nearest the side to which it is 
to be drawn. This makes quicker and smoother arranging 
possible. 

To change the mattress with a patient in bed.—The 

mattress may be changed with a patient in bed by remov¬ 
ing the upper bed clothes, leaving just a light weight 

cover over the patient. Have two or three chairs on the 
far side of the bed on to which the mattress can be slipped. 
Draw the patient to the side farthest from the chairs and 
slip the mattress half off on to them with the patient still 
lying on it. Place three pillows on the springs for a 
temporary mattress and draw the patient back on them. 
Go to the far side of the bed, remove the sheet and turn 
the mattress over (from the head to the foot), then re¬ 

place it half over the wire springs. Spread a fresh under¬ 
sheet and draw-sheet over the mattress and tuck in on one 
side. Lift the patient back on to it, remove the pillows, 
and draw the mattress into position. Tuck in the re¬ 
mainder of the lower sheets and replace the upper bed¬ 

ding and pillows. 

To change the patient to another bed. —Have a freshly 
made bed of corresponding height conveniently placed with 
the upper bedding folded back to the foot. Draw the 
patient to one side of the bed, loosen the draw-sheet 

and fold this over the patient while removing the upper 
bedding. Bring the two beds together and, going to 
the free side of the fresh bed, take the upper ends of the 
draw-sheet and the pillow (on which the head and shoul¬ 
ders rest) in one hand, and the lower end of the draw- 


BED-MAKING 


sheet in the other, and draw the patient carefully over to 
the other bed. Draw up the upper bedding, remove the 
draw-sheet and change the pillow. 

Note: This is more easily accomplished with an as¬ 

sistant. 

To relieve the weight of bed clothes.— If there is a 
foot rail or board to the bed, the weight of the bed clothes 
may be taken from the body by being drawn over the foot 
of the bed and fastened securely either under the mat¬ 
tress or around the foot rail. The corners and sides 
should be folded diagonally and pinned to exclude any 
draught. If the bed lacks a foot board a high back chair 
may be used as a substitute, or a cradle which comes for 
the purpose and extends across the patient’s legs beneath 
the bedding. Various substitutes may be improvised to 
keep the weight of the clothing off the body, such as a box 
with two sides knocked out. 

To prevent slipping down in bed. — i. One method of 
preventing slipping down consists in a board like a swing 
seat which may be placed upright against the feet. The 
tapes or cords at its sides are drawn tight and fastened 
to the head of the bed low down. The board should be 
deep enough to support the bedding and wide enough not to 
interfere with the moving of the patient’s feet, and should 
have a small, hair pillow placed against it as a foot rest. 

2. A sheet folded diagonally into 12-inch plaits may be 
used sirndarly, bringing it below the body so that the feet 
rest in its center on a small pillow, and fastening the ends 
securely to the sides of the bed. 

3. Another method is simply to put a large pillow be¬ 
neath the patient’s knees, or for this purpose a pillow can 
be fastened in a roll with tapes running through the center 
of the roll and these tied to the sides of the bed, thus keep¬ 
ing the pillow in position under the knee. 

Arrangement of pillows. Pillows, if well arranged, mean 
comfort to the patient, and the particular parts needing sup¬ 
port in general are:—(1) head and neck, (2) shoulders, (3) 
arms and elbows, (4) small of the back. 

It is easier to arrange pillows both for sitting up and 
when the patient can only be partly raised with the sup¬ 
port of a bed-rest or substitute—a tray or board or a stiff 
hair pillow. 

In changing a pillow (one under the head): have the 
: fresh one ready on the far side of the bed. Lift the pa¬ 
tient’s head and shoulders with one arm by reaching over 
the body and remove with the other hand the used pillow, 
substituting the fresh one at the same time. Have the 
pillow come well under the shoulders. 



BEDPAN 


When two pillows are used, if the patient is lying on 
the back, have the first and lower one well beneath the 
shoulder blades, with the second and upper one higher on 
the bed to support the neck and head, but still under the 
shoulder blades. 

When several pillows can be used, place the largest one 
nearest the patient’s back and arrange the others in over¬ 
lapping layers closer to the head of the bed. Slip small 
pillows under the elbows and neck and in the hollow of the 
back. 

Cage pillow. —A cage pillow may be built to resemble 
an arm-chair. Some firm support such as a stiff pillow or 
a backrest should be laid against the head of the bed 
(place a towel to protect from marking bed). Shake the 
pillows well and place the two largest into an inverted V 
behind the patient’s body, with the lower ends where they 
may support the elbows. Build two other pillows up on 
these in same way, bringing them closer to the body so that 
when the cage is complete the patient’s back and arms will 
be completely supported. A small pillow may be added for 
the support of the neck and the head. 

BEDPAN 

Giving a bedpan. —Warm the bedpan first, then turn the 
bedclothes slightly back. Have the patient flex the knees. 
Raise the hips, draw up the gown and insert the pan at 
right angles to the bed, turning it so that it lies in proper 
position under the patient. If the patient cannot raise the 
hips, have pan in position, flex the knees and with both 
your hands raise the hips; hold with one hand and insert 
the pan with the other. 

Removing bedpan. —Flex the patient’s knees, raise the 
hips, and withdraw the pan in same manner as it was in¬ 
serted. Cover and remove. Turn patient on the side and 
wash off the part. 

To prevent bedsores and for the comfort of the patient 
it is very necessary to raise the hips perfectly clear of the 
pan while inserting or removing. If a patient is emaci¬ 
ated, it will be more comfortable to place a rubber ring 
partly inflated with air over the bedpan before inserting. 
A small pillow or a folded towel should be placed under 
the small of the back with the end over the edge of the 
pan. 

BED SORES 

Pressure sores are usually spoken of as bed sores, al¬ 
though they can develop under any condition where there 
is a constant pressure on a part, as this prevents healthy 
circulation. 


BED SORES 


This pressure may come: (i) from the body being con¬ 
stantly in one position; (2) from one part pressing against 
another; (3) from moisture and uncleanliness of the skin; 
(4) from friction from the bedclothes or (5) from splints 
and bandages improperly adjusted. Paralytics and very 
thin or emaciated patients or those with otherwise lowered 
vitality are especially susceptible to this danger. 

The most susceptible parts are the lower end of the 
spine, the buttocks, hips, heels, knees, ankles, toes, elbows 
and ears. When placing or removing a bedpan special 
care should be taken to raise the hips sufficiently to avoid 
rubbing the surface against the pan. 

Prevention of pressure sores. Bathing and rubbing. 
Bathe the parts frequently. Keep the skin dry and stimu¬ 
late it by rubbing, using a little lubricant on the hand 

and rubbing with a smooth, firm touch in circular motions. 
This is always to be followed by rubbing with alcohol, which 
leaves the skin dry, hardened, and less liable to break down. 
Then apply talcum or stereate of zinc powder. 

Remove pressure. —If a patient can be turned, change 
the position frequently as the simplest way to remove pres¬ 
sure. If this cannot be done, the pressure must be kept 
away from the susceptible parts by the use of rubber or 

cotton rings, air pillows, or an air mattress. 

For the lower part of the back, a rubber ring is neces¬ 
sary. This should be covered with a bandage or should 

be slipped into a pillow case. This ring should be only 
partly inflated, otherwise it will be hard, uncomfortable, 
and may itself cause irritating pressure. In case of a 
very heavy patient, two such rings can be used, one on top 
of the other, both only partly inflated and tied together by 
a bandage or adhesive plaster. Be sure that the part to 
be protected does not touch the surface under the ring. 
To ease the consequent strain on the muscles, place a pillow 
in the hollow of the back. Rings made of cotton and 
covered with bandage, or air pillows, can be utilized to 
keep pressure off various parts of the body. A hot water 
bag partly filled with air makes a good substitute for 
such a pillow. 

Signs of development of bed sores. —If a patient com¬ 
plains of stinging when rubbed with alcohol, stop the 
use of alcohol at once as this sensation indicates that the 
skin is nearly broken. Apply stereate of zinc powder or 
oxide of zinc ointment over the part. Remove all pressure 
and rub around the part towards the wound and not 
away from it. This will improve the general circulation 
at that part. 

Always notice the least sign of redness of the skin. 


BEER 


Bed sore wound. —Report the first sign of a bedsore to 
the physician. When a sore has formed follow orders as 
to dressing, etc. It should be treated as any wound, but 
particular care must be given to those developing around 
the hips and buttocks in order to prevent fecal matter or 
urine from infecting them. Remove all pressure. 

If the skin is reddened or sore from pressure from 
splints or bandages these must be readjusted and the skin 
rubbed with alcohol and alum (to harden it) and well 
powdered. 

A patient who is constantly sitting in a chair requires 
care to prevent pressure sores. Rubber rings and air or 
soft hair pillows can be adjusted to relieve such pressure, 
and the arms of the patient must also be protected in many 
cases by the same method. Patients suffering from any 
form of paralysis are very susceptible to this danger. 

BEER 

See Alcohol. 

BELLADONNA AND ATROPINE 

Belladonna is a drug obtained from the leaves and roots of 
the Atropa belladonna or Deadly nightshade. 

Its active principles are the following alkaloids: Atropine, 
Hyoscyamine, and Hyoscine. The effects of belladonna are 
due principally to the atropine which it contains. This is 
preferred for internal use. 

Appearance of the Patient 

After administration of atropine, belladonna or hyoscya- 
mus, the following effects result within ten minutes to a half 
hour: 

The patient looks brighter, the face and neck are some¬ 
what flushed, and the pupils are dilated. He is more wake¬ 
ful and brighter. 

The pulse is rapid and strong and the breathing is deeper 
and faster. Various cramp-like pains, such as pains in the 
stomach, intestines, or bladder, from which the patient may 
be suffering, are relieved. 

The patent is thirsty, complains of dryness of the mouth 
and throat. The skin usually feels dry, and may be quite 
red. 

If the patient has an attack of shortness of breath, this is 
usually relieved. 

Action 

Local action: On the skin, atropine relieves pain, and 
checks the secretion of sweat. This effect is produced by 
paralyzing the sensory nerve endings in the skin. It is 


BELLADONNA 


often used for this purpose in the form of a belladonna 
plaster. Atropine or belladonna is readily absorbed from the 
skin if applied in a solution of alcohol, glycerin, oil, or 
camphor, or in the form of plaster. It often causes general, 
even poisonous symptoms from such applications. On mucous 
membranes: It checks the secretion. 

In the mouth: Atropine has a bitter, burning taste, and 
checks the secretion of saliva and mucus. It makes the 
mouth and throat feel dry. If this effect is marked, the 
patient is unable to swallow. 

In the stomach: It lessens the secretion of gastric juice 
and the peristalsis of the stomach. 

In the intestines: Atropine checks the secretion of the 
mucous membrane of the intestines and lessens the peri¬ 
staltic contractions of its muscle wall. It is often used for 
this purpose to check the griping pains of cathartics. 

Action on the heart: Atropine makes the heart beat 
faster and stronger. —The systoles, or periods of contraction 
of the heart are increased, while the diastoles or periods 
of relaxation are lessened. The heart then expels more 
blood; and with greater force. 

Action on the blood vessels: The small arteries of the 
abdomen are constricted by the contractions of their muscle 
fibers. The blood vessels of the skin, however, are widened. 
This causes flushing of the face and neck. 

Atropine makes the pulse rapid, strong, and tense. There 
may be a slight increase in blood pressure. 

Action *on the respiration: Atropine makes the breathing 
faster and deeper; more air, and therefore more oxygen, is 
taken into the lungs. The blood is then able to take up 
more oxygen and to eliminate the carbon dioxide more 
rapidly. 

Action on the nervous system: Atropine increases the ac¬ 
tivity of the brain; this produces wakefulness and rest¬ 
lessness. The higher intellectual activities, such as rea¬ 
soning and memory are not affected, however. 

The patient is more active and more talkative, because 
the motor and speech areas of the brain are more active, 
and these areas are constantly sending out more impulses. 

In overdoses, atropine causes symptoms of lessened brain 
activity (depression), because the brain then becomes ex¬ 
hausted from overactivity. 

Action on the secretory glands: Atropine lessens the se¬ 
cretion of all the secretory glands except the kidneys. 

Action on the involuntary muscles: Atropine lessens the 
contractions of all the involuntary muscles, by paralyzing 
the nerve endings of the nerves which carry impulses to these 
muscles. Thus, the peristalsis of the stomach and intestines, 


BELLADONNA 


the contractions of the bladder, of the uterus, and of the 
bronchial muscles are all lessened by atropine. 

Action on the pupil: Atropine dilates the pupil by paralyz¬ 
ing the nerve endings of the nerves in the circular muscle 
fibers of the iris. The pupil may remain dilated for days. 

Effect on the temperature: In large doses atropine often 
causes a rise of temperature. 

Excretion 

Atropine or a drug containing atropine, is excreted mainly 
by the kidneys, in about ten to twenty hours. 

Idiosyncrasies 

The following unusual effects occasionally occur: 

1. Ordinary doses of atropine sometimes cause delirium. 

2. When applied to the conjunctiva of the eye, atropine 
often causes inflammation of the eyelids and face. 

3. The rash caused by atropine may spread all over the 
body, and may be mistaken for scarlet fever. 

Poisonous Effects 

Dangerous symptoms have resulted from 1/20 to 1/10 of a 
grain and death has occurred in about six hours after it 
was taken. 

Symptoms. —In giving atropine or atropine containing 
drugs the nurse should watch for excessive thirst and talka¬ 
tiveness. She should report these symptoms to the physician 
as soon as they occur. 

The earliest and most characteristic symptoms of atropine 
poisoning are the following: 

1. Dryness of the mouth and throat. 

2. Excessive thirst. 

3. Difficulty in swallowing. 

4. Hoarseness. 

5. Flushed, dry skin, especially of the face and neck. 

6. Very rapid pulse and breathing. 

7. The pupils are widely dilated and near objects can¬ 
not be seen distinctly. 

If very large doses of atropine are taken, these symptoms 
are increased and may be followed by: 

1. Hoarseness, with difficult and indistinct speech, and 
talkativeness. 

2. Restlessness and wakeful delirium. 

The patient is very talkative, but his ideas are confused. 
He may begin a sentence and not finish it. He is very light¬ 
headed, may burst into fits of laughter or tears. Occasion¬ 
ally there may be illusions or hallucinations of sight. 

Soon a peculiar, wakeful, active, and talkative delirium 
develops. The excitement is usually followed by collapse: 


BELLADONNA 


the skin becomes pale, cold and clammy, the pulse becomes 
rapid and weak, the breathing slow and shallow, and death 
may result. Frequently the excessive excitement is followed 
by stupor and coma, with slow and shallow breathing and 
cyanosis. Finally, tremors of the muscles and convulsions 
develop, the breathing becomes slow and shallow, the face 
becomes blue, and the patient dies from paralysis of res¬ 
piration. 

Although atropine is a respiratory stimulant, the nurse 
should remember that from poisonous doses the respiratory 
center becomes depressed and may finally be entirely par¬ 
alyzed and death ensue. 

Treatment of Atropine Poisoning. — i. Wash out the 
stomach, or give emetics. 

2. Give tannic acid or old tea to combine with the atro¬ 
pine and neutralize it. 

3. Catheterize the patient, to avoid reabsorption of the 
atropine from the urine in the bladder. 

4. Keep the body warm; give mustard baths. 

5. Give artificial respiration if the breathing is embar¬ 
rassed. 

6. Stimulants, such as caffeine or strychnine, are usually 
given. 

7. Do not give morphine; for, while atropine is the 

antidote for morphine, the dangerous effects of atropine are 

due to the exhaustion of the breathing. If morphine is 

given in such cases, the breathing is only made slower. 

Uses 

The following are the most important uses of atropine or 
belladonna: 

1. In the form of a belladonna plaster or liniment, to 

relieve pain. 

2. As a cardiac and respiratory stimulant, especially 
where immediate effects are desired. 

3. As an antidote for morphine poisoning. It is very 

often given together with morphine to avoid poisonous 
effects. 

4. To check secretions, for example, to check profusf 
sweating, or the secretion of milk. 

5. To lessen cramp-like pains produced by contraction} 
of involuntary muscles. It is often prescribed together with 
purgatives to lessen their griping. It relieves the colic 
which is produced by the contractions of the involuntary 
muscles of the bile ducts resulting from the passage of a 
gall stone along these ducts. It also relieves the colic of 
the ureters of the kidney (renal colic) resulting from the 
passage of a stone or other substance along the ureter. 


BENZOIC ACID 


It frequently relieves painful urination produced by tht 
spasmodic contractions of the involuntary muscles at the 
neck of the bladder. 

6. Atropine is very often used to relieve bronchial asthma. 

7. Atropine is very often used to dilate the pupil, so that 
the retina or background of the eye may be more easily 
examined, and to prevent adhesions between the iris and 
lens, when the iris is inflamed. 

8. It is very often used in diabetes in large doses. It 
lessens the amount of sugar in the urine. 

Preparations 

Extract of Belladonna Leaves; dose Via to V2 of a grain. 

Tincture of Belladonna Leaves; dose 5 to 15 minims. 

Belladonna Ointment; this contains about 10 per cent, 
of the extract of belladonna. 

Belladonna Plaster; this contains 3 parts of the extract, 
of belladonna and 7 parts of adhesive plaster. 

Fluidextract of Belladonna Root; dose 1 to 2 minims. 

Belladonna Liniment; this consists of the fluid extract to 
which has been added about 5 per cent, of camphor. 

Preparations of Atropine 

Atropine; dose l/l 60 to Veo of a grain. 

Atropine Sulphate; dose Viao to ^0 of a grain. 

For hypodermic use, atropine often comes in tablets, 
each containing the required dose, or in % to 1 per cent, 
solutions. 

Oleate of Atropine; this contains about 2 per cent, of 
atropine. 

Homatropine 

Homatropine is an artificial alkaloid of atropine. The 
effects are similar to those of atropine. It dilates the pupil 
more rapidly than atropine, and the effect is not as lasting. 
It is not so apt to cause general symptoms as easily as 
atropine from its local use; as in applications to the eye. 
Homatropine is used principally to dilate the pupil, by 
dropping a solution of the drug into the conjuctiva of the 
eye. 

Preparation 

Homatropine Hydrobromide; dose 1/100 to %0 of a grain. 

This is used principally in to 1 per cent, solutions for 
local applications to the eye. 

BENZOIC ACID AND ITS SALTS 

Benzoic acid is an organic acid obtained from benzoin; 
the hardened sap of the Styrax benzoini, a Peruvian tree. 

Local action: Applied to the skin or mucous membranes 


BENZYL BENZOATE 


benzoic acid acts as an antiseptic. It a»so increases the 
secretion of all mucous membranes. 

Internal action: When taken internally, benzoic acid or 
its compounds check the growth of bacteria in the intes¬ 
tines. 

It is eliminated by the urine, which it slightly increases. 
It acts as an antiseptic along the urinary tract. It is ex¬ 
creted as hippuric acid, which makes the urine more acid 
in reaction. 

Preparations 

Benzoic Acid; dose 5 to 15 grains. 

Sodium Benzoate; dose 5 to 30 grains. 

This is used principally as a urinary antiseptic. It is 
also frequently used as a preservative for canned foods. 

Ammonium Benzoate; dose 5 to 30 grains. 

Lithium Benzoate, dose 5 to 30 grains. 

Benzoin 

This is the thickened sap obtained from the Styrax 
benzoini, a Peruvian tree. Its compounds are used prin¬ 
cipally to increase the secretions in the lungs, and in inflam¬ 
mations of the nose and bronchi. 

Tincture of Benzoin; dose 30 to 60 minims. 

Compound Tincture of Benzoin; dose, one half to two 
drams. 

This contains benzoin, styrax, aloes and balsam of Tolu. 
It was formerly known as Balsamum traumaticum. It is 
contained in a number of old remedies, such as Friar’s bal¬ 
sam, Turlington’s balsam, Jesuit’s drops, etc. It is fre¬ 
quently given by inhalation for inflammations of the larynx 
and bronchi. Benzoin is also contained in the balsam of 
Peru and balsam of Tolu. 


BENZOIN 

See Benzoic Acid. 

BENZOL 

Benzol is an oily liquid made from coal tar. It is given 
in capsules in doses of 10 to 15 grains in the treatment 
of leukemia (a disease in which the number of white cor¬ 
puscles is very greatly increased). Benzol must not be 
confounded with benzine, an entirely different substance 
made from petroleum oil. 

BENZYL BENZOATE 

Benzyl benzoate is a colorless oily liquid formed by the 
combination of benzyl alcohol with benzoic acid. Benzyl 
benzoate may be obtained by the distillation of balsam of 


BERBERINE 


Peru or the balsam of Tolu. It is also present in various 
other balsams and in the volatile oils of various flowers. 

Action. —Benzyl benzoate, like papaverine, acts principally 
on the involuntary muscles, but it is much more efficient. 
It relieves the spasm of all involuntary muscles such as those 
of the intestines, the gall bladder, the ureters, the bronchi 
and the blood vessels. 

It is used principally to check the pains due to spasm 
in gall stone colic, kidney colic and abdominal cramps. It 
is also used to check diarrhea in chronic dysentery and 
mucous colitis and to lower blood pressure. 

Administration. —Benzyl benzoate has a very unpleasant 
taste. It should therefore be given in a thick syrup. It 
is usually prescribed in the form of a thick mixture wth 
mucilage of acacia and flavored with a syrup or an elixir. 

Preparation 

Benzyl benzoate; dose io to 30 minims. 

This is a liquid which is a 20 per cent, alcoholic solution. 

BERBERINT! 

See Hydrastis. 

BETANAPHTHOL 

See Naphthalene. 

BETOL 

See Naphthalene. 

BILE DUCTS 

See Liver. 

BINET-SIMON INTELLIGENCE TESTS 

See Mental Deficiency. 

BIRTH 

See Labor. 

BIRTH, PREMATURE 

See Abortion, Labor. 

BISMUTH 

Bismuth is a crystalline metal. Many of its insoluble 
salts are used as medicines. 

Poisonous Effects 

Bismuth poisoning occasionally results when it is used for 
a long time; especially in the form of dressings. Such ap¬ 
plications are more apt to cause poisonous symptoms than 
its internal administration. 


BITES 


Symptoms. —The following symptoms, which resemble those 
of mercury poisoning, appear very slowly: 

1. Profuse flow of saliva. 

2. Swelling of the gums, tongue and throat, often with 
destruction of the soft palate, and other portions of the 
mucous membrane of the mouth. 

3. Vomiting and diarrhea. 

4. Albumin in the urine. 

The symptoms usually disappear when the dressings are 
removed. 


Uses 

Bismuth salts are used as dusting powders on the skin, as 
astringents, as antiseptics and to promote healing of ulcers, 
and sinuses. 

They are principally used to coat, protect and heal ulcers 
of the stomach, and as an astringent to check diarrhea. 
They are often used to lessen nausea and vomiting. The 
stools usually turn black when bismuth is being given. This 
is due to the formation of bismuth sulphide. 

Large quantities of bismuth pastes are often given to coat 
the mucous membranes of the esophagus, stomach and 
intestines so as to enable an X-ray picture to be taken. The 
bismuth is not penetrated by the X-rays, so that the organ 
containing the bismuth produces a dark shadow on the 
picture. 

Preparations 

Bismuth Subnitrate; dose 5 to 30 grains. 

Bismuth Subcarbonate; dose 5 to 30 grains. 

Bismuth and Ammonium Citrate; dose 2 to 5 grains. 

This is more injurious to the tissues than the other prep¬ 
arations. 

Bismuth Subgallate (Dermatol); dose 5 to 20 grains. 

Bismuth Subgallate Preparations 

Airol (Bismuth Oxyiodogallate) . This is a combination 
of bismuth oxyiodide and gallic acid. It liberates iodine and 
is used as a local application to wounds, in 10 per cent, 
solutions in glycerin or in a 10 or 20 per cent, ointment. 

BITES AND STINGS 

Snake bites if poisonous cause pain, swelling and dis¬ 
coloration within a few minutes—blood poisoning, pros¬ 
tration and collapse may follow very quickly. The treat¬ 
ment is to prevent the poison from entering the general 
circulation and to treat for shock. Several tourniquets are 
applied at different levels, the wound is freely incised, 
and bleeding is encouraged—wet cupping is sometimes used 


BLACK DRAUGHT 


for this purpose. The wound may be swabbed with pure 
carbolic or cauterized. It should never be sucked as a slight 
abrasion on the lip would allow absorption of the poison. 
Complete rest, external heat and stimulants are necessary 
to counteract the shock. The tourniquets are removed one 
at a time (the one nearest the body first) if no symptoms of 
general poisoning appear. 

Poisonous bites from spiders are treated in the same way. 
The poison from stings of bees or wasps, etc., is acid and 
may, therefore, best be treated by alkaline solutions such 
as ammonia water, bicarbonate of soda, soap and water or 
a paste made of baking soda. The sting if left in should first 
be removed. This can be done by pressing firmly on the 
tissues around the wound with a round, hollow object such 
as a key. Cold or hot compresses moistened with an alka¬ 
line solution may be applied—hot applications are fre¬ 
quently more soothing. Shock may be severe when stings 
are caused by a swarm of bees. Bromides and morphine are 
given to relieve pain and nervousness. 

When the bites result in severe itching a weak solution 
of carbolic acid relieves it, due to its anesthetic effect on 
nerve endings. 

BLACK DRAUGHT 

See Senna. 

BLACK DROP 

See Opium. 

BLACK WASH 

See Mercury. 

BLADDER 

The bladder is a hollow muscular organ situated in the 
pelvic cavity behind the pubes, in front of the rectum in 
the male, and in front of the anterior wall of the vagina, 
and the neck of the uterus, in the female. It is a freely 
movable organ, but is held in position by ligaments. Dur¬ 
ing infancy it is conical in shape and projects above the 
upper border of the pubes into the hypogastric region. In 
the adult, when quite empty, it is placed deeply in the 
pelvis; when slightly distended, it has a round form; but 
when greatly distended, it is ovoid in shape and arises to 
a considerable height in the abdominal cavity. It is cus¬ 
tomary to speak of the widest part as the fundus, and the 
part where the bladder becomes continuous with the ure¬ 
thra as the neck. It has four coats: Serous, muscular, 
areolar and mucous. 

Function. —The bladder serves as a reservoir for the 


BLADDER IRRIGATION 


reception of urine. When moderately distended, it holds 
about one pint. 


BLADDER INSTILLATION 

In the treatment of cystitis, various antiseptic solutions 
—silver nitrate, argyrol, potassium permanganate, etc.—are 
sometimes introduced into the bladder as a local application 
to the mucous lining, in order to prevent the development 
of bacteria and decomposition of urine. 

The drug ordered may be introduced after the bladder has 
been emptied by catheterization, or a bladder irrigation may 
precede the treatment. 

In any case ‘the preparation is the same as for a bladder 
irrigation. In addition, a sterile measuring glass containing 
the drug will be necessary. Before pouring the drug into 
the sterile measuring glass, wipe off the rim of the bottle 
with alcohol and do not touch the glass with the bottle 
or anything else unsterile. 

When the patient has been catheterized or the bladder 
irrigated, without removing the catheter or funnel pour the 
drug into the funnel and allow it to flow slowly into the 
bladder. Finish as for a catheterization. Note whether 
the instillation caused the patient any pain; if so, a weaker 
solution will probably be required. 

See Bladder Irrigation, and Catheterization. 

BLADDER IRRIGATION 

A bladder irrigation is used when a patient is suffering 
from cystitis. 

Cystitis is inflammation of the mucous lining of the blad¬ 
der. 

Causes of Cystitis .—The direct cause is the presence of 
micro-organisms in the bladder. The organism may be the 
tubercle bacillus, the gonococcus, the colon bacillus, the 
staphylococcus pyogenes or the bacillus typhosus, etc. It 
may be carried to the bladder with the urine from the kid¬ 
neys or the blood stream, or it may enter from the urethra 
or the external genitals. 

The predisposing causes are (i) tumors; (2) calculi and 
other foreign bodies; (3) urethral inflammation or obstruc¬ 
tion; (4) injury; (5) exposure to cold; (6) atony, as in 
old age, resulting in retention and decomposition, or any¬ 
thing which interferes with the normal flow of urine; (7) 
paralysis as in paraplegia, etc. 

The urine in cystitis may have a fetid odor, due to the 
action of bacteria, or the odor of ammonia, due to decom¬ 
position of urine in the bladder. It may be cloudy or 
turbid, due to the presence of the products of inflammation, 


BLADDER IRRIGATION 


and may contain a large amount of mucus, many leucocytes, 
and epithelial cells, blood, pus, and calculi or gravel. 

The purposes of the treatment are: 

1. To cleanse or remove accumulated mucus, pus and 
other irritating products of inflammation and decomposition. 

2. To relieve pain, inflammation, and congestion. 

Bladder Irrigations are Contraindicated in the Following 
Conditions: 

1. In acute cystitis, until the acute stage has subsided, 
as the lining is so very sensitive. 

2. In acute urethritis, to avoid spreading the infection to 
the bladder. 

The Procedure. —The Articles Required .—These will de- 
depend somewhat upon the technique used. In addition to 
those used for catheterization, the following articles will be 
required: a sterile pitcher containing the sterile solution 
ordered and covered with a sterile towel, a receptacle for 
the return (a douche pan may be used), and a sterile glass 
funnel attached to the catheter to be used. Rubber cathe¬ 
ters are always used. Sterile draping is always advisable 
for a bladder irrigation. The treatment is much more 
complicated and prolonged than catheterization. It is also 
required less frequently, so that nurses may not have suffi¬ 
cient practice to develop the skill necessary before sterile 
draping can, with safety, be dispensed with. 

The solutions commonly used are: boric acid, 2 to 4 per 
cent., and sodium chloride one dram to a quart. Sodium 
chloride is stimulating; it cuts mucus and is cleansing, and 
it is less irritating than plain water. Other antiseptic solu¬ 
tions are sometimes used, such as potassium permanganate, 
bichloride of mercury, formalin, argyrol, and silver nitrate. 

The temperature of the solution for cleansing purposes 
should be near that of the interior of the body (the average 
temperature of the blood being 102° F.), as the mucous 
lining of the bladder is extremely sensitive to temperatures 
either much above or below that of the interior of the body. 
The temperature should be from 104° to 106° F.; if cool 
or hot it will cause marked contraction of the bladder wall 
with considerable pain. 

The amount of solution used varies, as the treatment is 
continued until the return is clear. Usually two or three 
pints are necessary. 

The position and preparation of the patient will be the 
same as for a catheterization. In this treatment it is ex¬ 
ceedingly important that you should avoid the slightest 
chilling of the patient, allowing as little exposure as pos¬ 
sible. Cold is one of the predisposing factors in cystitis 
and chilling may bring on an acute attack with very dis- 


BLEEDING FROM STOMACH 


tressing symptoms. Therefore, see that the feet and body 
are kept warm by using blankets. If the treatment is 
given with the douche pan under the patient for the ’-eturn, 
see that it is not placed under her before necessary, and see 
that it is well padded or protected as the treatment is rather 
lengthy. The douche pan should be warm. 

Method of Procedure. —Strict asepsis must be observed 
throughout. First empty the bladder by catheterization, 
using the rubber catheter with the funnel attached, insert¬ 
ing the catheter with the utmost care and gentleness Hold 
the funnel so that it will not be contaminated by contact 
with an unsterile surface. A long tube is unnecessary as 
no force should be used. 

After the bladder is emptied, the solution is poured into 
the funnel and allowed to run in slowly, with little force. 
The amount allowed to enter the bladder before siphonage 
varies from about i to 4 ounces, but the usual amount is 
about four ounces. When the bladder is very sensitive or 
when much contracted, sometimes it is impossible to intro¬ 
duce even one ounce without causing distress. Again when 
it is desired to distend the bladder completely, one pint may 
be injected before siphonage in order to smooth out the 
lining (which is. arranged in folds when the bladder is 
empty or contracted) so that the solution will reach and 
cleanse all parts. This is usually not permitted without ex¬ 
press orders from the doctor. As soon as the desired amount 
has been introduced and before the funnel is empty, it 
should be allowed to pass out immediately, allowing the 
bladder to empty itself normally and not pressing upon the 
lower abdomen to hasten its discharge. Before the bladder 
is quite empty, that is, before the return ceases to flow, 
introduce more solution so as to avoid the irritation which 
will result from the continued strong contraction of the 
bladder upon itself. 

This flushing of the bladder is continued until the return 
is clear. Finish as for a catheterization. 

See Catheterization. 

BLAUD’S PILLS 

See Iron. 

BLEACHING POWDER 

See Chlorine. 

BLEEDING 

See Hemorrhage. 

BLEEDING FROM STOMACH 

See Hematemesis. 


BLOOD, COMPOSITION OF 

BLOOD, COMPOSITION OF 

Seen with the naked eye, the blood appears opaque and 
homogeneous; but when examined with a microscope it is 
seen to consist of minute, solid particles called cells or 
corpuscles floating in a transparent, slightly yellowish fluid 
called plasma. 

{ Red or erythrocytes. 

White or leucocytes. 

Blood-platelets or thrombocytes. 


Proteins 


( Fibrinogen. 

J Paraglobulin or serum-globulin. 
I Serum-albumin. 


Extractives 


'Sugar (about o.i per cent.)INon-nitro 
Fats J genous. 

Amino-acid 
Urea 

Uric acid {►Nitrogenous. 

Creatin 
Creatinin 


Inorganic Salts 


Chlorides 

Sulphates 

Phosphates 

Carbonates 


of - 


Sodium. 

Calcium. 

Magnesium. 

Potassium. 

Iron. 


| Oxygen. 

Gases J Carbon dioxide. 

I Nitrogen. 


Internal Secretions 
Enzymes 


Special substances 
such as 


j Antithrombin. 

S Prothrombin or thrombogen. 


Antibodies 
such as 


'Agglutinins, 

Precipitins. 

Lysins. 

Opsonins. 

Antitoxins. 







BLOOD, FUNCTIONS OF 


BLOOD, FUNCTIONS OF 

Blood is commonly spoken of as the nutritive fluid of the 
body. This is correct, but it is more than a nutritive fluid, 
as will be seen from the following list of its functions:— 

(1) It serves as a medium for the interchange of gases, 
e.g., carries oxygen to the cells and carbon dioxide from the 
cells. 

(2) It serves as a medium for the interchange of nutritive 
and waste materials. It carries food to the cells and waste 
materials from the cells. 

(3) It serves as a medium for the transmission of internal 
secretions. The presence of these secretions controls the 
chemical activities of cells. 

(4) It aids in equalizing the temperature of the body. 

(5) It aids in protecting the body from toxic substances. 

BLOOD PRESSUBE 

The normal blood pressure is as follows (Cabot): Systolic 
(blood is streaming into the arteries) no to 135 mm. Hg.; 
Diastolic (the arteries are closed off from the heart) 60 to 
90 mm. Hg. The blood pressure is less in women than in 
men and lower still in children—90 to no mm. Hg., and in 
children under two years 75 to 90 mm. It is usually 
higher in old age. In disease, for instance, in nephritis, it 
may be 200 mm. and more. 

The sphygmomanometer is an instrument for accurately 
measuring the blood pressure by determining the exact pres¬ 
sure necessary to compress and obliterate the pulse. There 
are several forms of apparatus which may be used. 

BLOOD, TEST FOR 

See Urine. 


BLOOD, TRANSFUSION OF 

See Transfusion. 

BODY, COMPOSITION OF 

It has been estimated by various writers that the human 
body has an approximate average chemical composition of:— 


Oxygen . about 65 per cent 

Carbon. about 18 per cent 

Hydrogen . about 10 per cent 

Nitrogen . about 3 per cent 






BODY, COMPOSITION OF 


Calcium . about 2 per cent 

Phosphorus . about 1 per cent 

Potassium . about 0.3s per cent 

Sulphur . about 0.25 per cent 

Sodium . about 0.15 per cent 

Chlorine . about 0.15 per cent 

Magnesium . about 0.05 per cent 

Iron . about 0.004 P er cent 

Iodine ) 

Fluorine >. very minute quantities 

Silicon I 


BODY LICE 

See Lice. 

BOILING 

See Foods, Preparation of. 

BORAX 

See Boric Acid. 

BORIC ACID AND BORAX 

Boric or boracic acid is a weak acid formed by the action 
of sulphuric acid or borax. 

Local action: Applied to the skin or mucous membranes, 
boric acid checks the growth of bacteria, but does not de¬ 
stroy them (antiseptic). It is also soothing to the skin. 

Boric acid is rarely used internally, but when it is given, 
it increases the flow of urine. 

Poisonous Effects 

The irrigation of abscess cavities, the pleural cavity and 
other cavities of the body with boric acid, has occasionally 
caused the following symptoms: 

1. Abdominal pain. 

2. Nausea, vomiting and diarrhea. 

3. Headache and dimness of vision. 

4. Collapse; rapid, thready pulse, slow, shallow breathing 
and subnormal temperature. 

Death may result from the collapse. 

Continued use of boric acid, even in the form of wet 
dressings, causes scaly skin eruptions such as eczema, and 
baldness. 











BRADFORD FRAME 


Uses 

Boric acid is used as an antiseptic for mucous membranes 
such as the conjunctiva. It is especially valuable as a 
mouth wash and gargle because of its mild action, and it 
is the principal ingredient of most mouth washes. It is 
also used to irrigate wounds and abscess cavities. 

Preparations 

Boric Acid (Boracic Acid) ; dose 5 to 15 grains. 

For external use 2 to 5 per cent, solutions are employed. 

Sodium Borate (Borax); dose 5 to 15 grains. 

Boroglycerin (Glyceritum Boroglycerini) .—This is a 
compound formed by heating boric acid in glycerin. It con¬ 
tains 31 per cent, of boric acid. 

Liquor Antisepticus 

This is a compound containing 2 per cent, of boric acid to¬ 
gether with benzoic acid, thymol, eucalyptol, oil of peppermint 
and oil of thyme. It is marketed under the name of 
Glycothymoline. 

Dobell’s Solution 

This contains i }4 per cent, of borax, carbolic acid, sodium 
bicarbonate, glycerin and water. It is used as an alkaline 
gargle and as an antiseptic nasal douche. 

Boric Acid Ointment 

This contains 10 per cent, of boric acid. 

Listerine 

This is a compound containing 2^4 per cent, of boric acid, 
together with benzoic acid, thymol, eucalyptol, oil of winter- 
green, oil of peppermint, tincture of baptista, alcohol and 
water. 

BOROGLYCERIN 

See Boric Acid. 

BRADFORD FRAME 

The Bradford frame is used to restrain children in the 
treatment of fractures and diseases of the spine, hip and 
other joints. It may be used for restraint after operations, 
to relieve pressure on bedsores or wounds of the back and 
to protect dressings on the back or thighs from soiling by 
the involuntary passage of urine or stools. 

The frames are made of gas piping and vary in length 
and width according to the child. They should always be 
about a foot longer than the child and wide enough to 
avoid contact with the shoulders. Two pieces of canvas 


BRADYCARDIA 


are stretched across the frame and stitched securely to it. 
A space is left between the upper and 'ower strip wide 
enough to leave the buttocks free and allow the use of 
the bedpan. The frame and canvas are covered with a 
sheet. The child is placed on the canvas with the but¬ 
tocks directly over the space. Strips of canvas or other 
stout material are fastened to either side of the frame and 
are laced over the body of the child, holding him securely 
to the frame. The length of the strips varies with the case 
and the restraint required. They may extend from the 
axilla to the ankle or from the axilla to below the crest 
of the ilium with separate strips to restrain one or both 
legs. A cotton ring should be placed under the heel of the 
restrained limb to prevent pressure sores. The frame may 
be fastened to the sides of the bed. When used to prevent 
soiling of dressings from urine, etc., the frame is sus¬ 
pended from the sides of the crib and the bedpan is left 
on the bed under the buttocks. The lower canvas should 
be protected by a rubber. When used to prevent pressure 
the frame is suspended and the canvas adjusted so as to 
leave the wound or tender spot free from contact with the 
canvas or bed. The mattress of the bed may be covered 
with a rubber sheet or spread. The child is covered with 
the usual bedclothes. 

BRADYCARDIA 

When the rate of the pulse is abnormally slow or infre¬ 
quent the condition is called bradycardia (slow heart.) A 
slow pulse usually occurs in exhaustion after severe exer¬ 
cise and in convalescence following acute diseases, in tox¬ 
emia—auto-intoxication, uremia, and jaundice (bile in the 
blood poisons and weakens the muscle of the heart); in 
some cases of hysteria and melancholia; in accidents, such 
as a fracture of the skull causing pressure on the base of 
the brain; in irritation or pressure on the vagus nerve which 
slows the pulse rate; in increased intracranial pressure, as 
in apoplexy and meningitis, and as a result of the action of 
drugs, such as opium, which depresses the nervous system, 
and digitalis, which stimulates the vagus nerve and there¬ 
fore slows the heart beat. 

BRAIN, SURGICAL CONDITIONS OF 
Brain Abscess 

Occasionally, septic complications, or intracranial sup¬ 
puration may follow compound fractures of the skull, cere¬ 
bral injuries, ‘infections of the middle ear, and disease of 
the mastoid antrum. The diagnosis is sometimes very diffi¬ 
cult, and the treatment is dependent upon the location of 


BRAIN, SURGICAL CONDITIONS OF 


the focus. As for abscesses in other parts of the body, the 
immediate indication is drainage. In the brain abscess this 
presupposes a craniotomy with drainage of the abscess cavity. 

if the abscess is due to a suppurating middle ear, the 
treatment is a little more involved. To begin with, if 
pus is present in the middle ear, it must be freely drained 
by incising the drum. This is often done under gas, and 
the tympanic membrane incised by a small, spear-like knife. 
Some surgeons are not in favor of syringing the ear in the 
beginning, but keep the drainage free by wiping the meatus 
clean with cotton several times a day. Others prefer to 
have the ear syringed almost immediately with warm boric 
acid solution at least three times a day. 

Mastoiditis and Sinus Thrombosis 

If the pus spreads from the middle ear it frequently 
causes an infection of the mastoid cells (mastoiditis); if 
it enters the region of the lateral sinus (really a vein run¬ 
ning in a groove of the temporal bone) a sinus thrombosis 
may result. These conditions are treated by surgical in¬ 
tervention. 

Ante-operative Treatment. —The hair in the region of the 
ear should be shaved for a considerable extent, and if the 
jugular vein is to be ligated, the neck should always be very 
carefully prepared. 

Operation. —The operation consists in laying open and 
gouging out the mastoid cells, and if sinus thrombosis is 
present, an exposure of the lateral sinus. In case the sinus 
is involved before it is incised, the vein into which it drains 
(internal jugular) is ligated in the neck. The reason for 
this is to prevent the spread of infection down the jugular 
vein into the general circulation. After the vein has been 
ligated, the sinus is incised, the clot removed by careful 
flushings with warm saline solution, and the sinus packed. 

After-Treatment. —Patients suffering from a sinus throm¬ 
bosis are very sick. As a rule, they are septic and, like 
all those cases, require plenty of fluid and sufficient calories 
to supply the energy their constitutions demand to fight 
the bacteria in the blood. Not only should they be given 
saline freely by rectum, but, if necessary, also glucose in¬ 
fusions of from five to ten per cent, in strength. If patients 
are anemic, transfusions of blood are indicated, and should 
be given frequently until the blood cultures are negative, 
or the red blood cells and hemoglobin have increased to 
within normal limits. The wounds are dressed daily, 
cleaned carefully and packed anew; the dressings are held 
in place by bandages. 


BRAIN, SURGICAL CONDITIONS OF 
Brain Injuries 

The brain is enclosed within a bony case, the skull, 
and a severe injury inflicted upon the head may not only 
injure the scalp and fracture the skull, but also cause various 
injuries to the brain within. The immediate effect of the 
injury or concussion may be unconsciousness brought on by 
shock of the nerve centers of the brain. In addition, some 

blood vessels of the dura or pia mater may be torn, with 

a resultant intracranial hemorrhage causing compression of 
the brain. This manifests itself by unconsciousness, irregu¬ 
lar respirations of the Cheyne-Stokes type, slow pulse, in¬ 
creasing of the blood pressure, and what is called a “choked 

disc” (serous inflammation of the optic nerve). This may 

be seen with an ophthalmoscope, an instrument through which 
the interior of the eye is inspected. 

As these patients are in shock, they should first be treated 
for this condition, but they should never be placed in the 
shock position. In fact, the head should be elevated slightly. 
The room must be quiet and darkened, and all .visitors for¬ 
bidden. As a rule, an enema is given, and if the bladder 
is at all distended, a catheter is inserted, and the urine 
drawn off. Patients, after they have recovered conscious¬ 
ness, should be confined to bed for at least a week and 
watched very carefully, because very often peculiar mental 
symptoms may follow in the wake of a concussion, and it 
is not safe to leave such cases alone. 

Treatment of Compression. —This presupposes a hem¬ 
orrhage, either extra-dural or subdural. The extra-dural 
hemorrhage results from a rupture of one of the branches 
of the middle meningeal artery. Subdural hemorrhage is 
due to a rupture of one of the vessels of the pia mater, or 
a laceration of the brain with its vessels. 

Ante-operative Treatment. —The head is shaved completely 
and iodinized. If the patient is unconscious, no anesthetic 
is required; if not, a little chloroform is sufficient. The 
head is supported on a sand bag, or small prop. 

Operation. —A curved incision is made in the temporal re¬ 
gion of the head, the temporal muscle turned down, and an 
opening made into the skull by means of an instrument 
called a trephine. This, by virtue of its circular serrated 
end, cuts out a button of bone. After the bone has been 
removed, the dura beneath is exposed. If better exposure 
is necessary, it may be obtained by enlarging this opening, 
by clipping away more bone with the bone-cutting forceps, 
or if the surgeon prefers to keep the bone intact, he may 
make two more trephine openings, and connect them with 
cuts made by a Gigli saw. This will remove one large plate 


BRAIN, SURGICAL CONDITIONS OF 


of bone that may afterwards be replaced. The clot is then 
removed, and the bleeding vessels are found and ligated, 
or special Cushing clips (small metal clips) are placed upon 
the artery. If the bleeding is subdural, the dura is incised, 
and the source of the hemorrhage sought and controlled. 
The dura is then closed with interrupted sutures. The 
bone which had been kept in warm sterile saline is replaced 
into the skull, as a rule, and the wound closed with or 
without drainage. A good tight pressure bandage is applied 
over the entire head. 

After-Treatment. —Patients should be kept in bed for about 
two weeks. During this period they should be allowed very 
few visitors, and absolutely no excitement. They should 
never be left alone. If unconscious, catheterization should 
be performed every eight hours, and the bowels moved by 
enema once a day, unless incontinence is present. In these 
pitiable cases great care must be taken to keep the patient 
exceptionally clean and free from feces and urine. Un¬ 
conscious patients must be turned every four hours so as 
to prevent pressure necroses or bed sores, which are always 
a bad reflection on the nursing care, although often abso¬ 
lutely unavoidable. If the skin, especially around the bony 
prominences such as the sacrum, the heels, and elbows, be 
carefully bathed with alcohol, gently massaged and powdered 
there is very little danger of this necrosis taking place, 
particularly if these regions are elevated for a few hours 
each day by inflated rubber rings. During convalescence, 
the patient’s mind should not be subjected to any mental 
strain whatsoever, and the surroundings should be very 
quiet. 


Tumors of the Brain 

The brain may be the seat of a tumor either benign or 
malignant in nature. As the mass within the cranial cavity 
grows, it crowds the brain and produces signs of compression 
with its resultant symptoms. In addition, there will be 
other physical signs dependent upon the area of the brain 
that is infiltrated by the new tissue, or compressed by the 
tumor mass. If the motor area is pressed upon, there may 
be paralysis; if the speech area is involved, there will be 
paralysis of those muscles which they innervate or loss of 
function of the nerves supplying the organs of special 
sense, as the eye, ear and nose. 

Treatment. —If the tumor mass is localized, an operation 
is done; an exploratory craniotomy is performed, and the 
trephine opening is made in that portion of the skull over- 
lying the brain tumor area. 


BRAND BATH 


Occasionally, the tumor may be extirpated in toto, but if 
it is found to be inoperable, a plate of bone is removed in 
the temporal region, and the brain permitted to herniate 
against the temporal muscle. This operation is called “sub¬ 
temporal decompression.” Sometimes in tumors of the cere¬ 
bellum, part of the occipital bone is removed, or an occipital 
decompression is done. This procedure temporarily relieves 
intracranial pressure, and with it, the terrible persistent head¬ 
aches which torture these unfortunate individuals almost 
to distraction. Patients are confined to bed for three to four 
weeks. 

BRAND BATH 

This is the cold tub bath used in the treatment of typhoid 
fever. It consists in the complete immersion of the body 
in a bath at 95 to 85° F., or at 85 to 70° F., for from ten 
to twenty minutes. Some doctors prefer to use the bath at 
the higher temperatures given, believing that the results 
are better and that the shock, excitement, alarm and resist¬ 
ance of the patient to the extreme low temperature may do 
harm. The bath is accompanied by friction to the whole 
body surface throughout the treatment. 

Effects of the Bath. —The nerve centers are stimulated 
and restored; vital resistance is increased; muscle tone, the 
activities of the kidneys, liver and skin are all increased. 
The amount of oxygen received and of carbon dioxide 
eliminated is nearly three times the normal amount, showing 
a marked increase of oxidation in the body. Bloodpressure 
is increased, the pulse is slowed, the heart is strengthened 
and stimulated and the number of blood corpuscles, espe¬ 
cially the white cells, is increased. 

The typhoid tub bath is usually given every three or four 
hours when the temperature is 102° or 103°, not because 
the lowering of the temperature is the primary object, but 
because the temperature runs parallel with and is a definite, 
easily determined indicator of the increased toxicity of the 
body. The patient dies from the effects of toxins in the 
body, and not from the increased temperature. In fact, 
the increased temperature is now believed to be a defensive 
reaction on the part of the body—an effort to destroy and 
to repel the germs which cannot live in a higher temperature. 

The typhoid tub bath, therefore, aims to destroy and 
eliminate the toxins and prevent or relieve their poisonous 
effects on the body. 

It is contraindicated in 

1. Infancy, old age or inability to react. 

2. Shivering, sweating, a subnormal temperature or col¬ 
lapse. 


BRAND BATH 


3. Threatened intestinal hemorrhage or perforation. 

4. The presence of blood in the urine. 

5. In skin diseases, pneumonia, nephritis, and other acute 
inflammatory conditions. 

Method of Procedure. —Strict typhoid precautions must 
be observed throughout the treatment. 

Preparation of the Patient. —The patient is covered with 
a sheet. The upper bedclothes are removed or fanned to 
the foot of the bed. The patient’s gown is removed and his 
loins are draped. The canvas usually used for lifting and 
supporting the patient in the tub is then put carefully under 
him. The poles, used for lifting, are then inserted in the 
canvas. He should be disturbed as little as possible and 
prevented from exerting himself in any way. Non-absorb¬ 
ent cotton may be placed in the ears to avoid the accidental 
entrance of cold water, as this may cause earache, head¬ 
ache, dizziness and nausea. Cold applications are applied 
to the head and face, the temperature of the application 
being much lower than that of the bath. 

Preparation of the Bath and Method of Giving. —Before 
the patient is prepared the necessary articles and utensils 
are brought to the bedside. The tub is filled about two- 
thirds with water at the required temperature, and is 
brought to the bedside. Two people lift the patient on the 
stretcher very care tolly, but as quickly as possible, from 
the bed into the water. The sheet covering the patient is 
not removed until after he is in the bath. No exposure 
should be allowed. The patient must be immersed to the 
neck, care being taken not to leave the shoulders uncovered 
as this would allow evaporation and cause chilling and 
possibly pneumonia. The head is supported with a rubber 
pillow or air-ring. The sheet is then removed. The patient 
must be in a comfortable position and supported so as to 
avoid all strain or exertion. 

During the bath friction is applied throughout the whole 
treatment. Friction is not applied to the abdomen. Hair 
on the chest, if long and plentiful, should be cut short, 
because the rubbing and bathing make the hair follicles 
red, swollen and painful. The cold applications on the head 
should be changed frequently and their temperature kept 
constantly lower than that of the bath. 

The patient will shiver and complain of chilliness at first. 
If he continues to shiver, if his teeth chatter and his skin 
becomes cyanotic, stop the treatment. Remove him at once 
from the bath, cover him with a sheet and blanket and rub 
until reaction sets in. A patient is not, as a rule, removed 
from the bath because he complains of chilliness unless his 
teeth chatter. Treatments are not as a rule discontinued 


BRANDY 


because of chilliness, but the doctor may order whiskey 
or may raise the temperature or shorten the duration of 
the bath, or friction may be increased. The patient’s pulse 
should be watched carefully. He should be watched closely 
for symptoms of chill or cyanosis, and for symptoms of 
hemorrhage or perforation on account of moving the patient. 

The duration of the bath is usually ten minutes unless 
otherwise ordered. 

While the patient is in the bath, his bed may be com¬ 
pletely remade or the linen may be tightened and freshened, 
then covered with a large rubber. 

When the bath is completed, the patient is again covered 
with the sheet and the loin draping is removed. Two people, 
as before, carefully lift the stretcher and the patient and 
hold it over the tub to allow the water to drain off before 
placing it on the bed. The cold applications are then removed 
from the head and the patient is dried with the sheet. As 
the patient is turned from side to side, the wet rubber and 
canvas may be removed and the back dried and rubbed 
with alcohol and talcum. The patient’s gown, the pillows and 
bedclothes are replaced and the damp sheet removed. 

The patient’s temperature is usually taken one hour after 
the bath. Some doctor’s prefer, however, that the patient, 
if sleeping, should not be disturbed for this purpose, as a 
natural sleep is one of the effects for which the bath is 
given. A nurse should find out from the doctor what his 
wishes are in this respect. Sleep must not be confused 
with a toxic condition of stupor. In this condition, taking 
the temperature will not disturb the patient. 

BRANDY 

See Alcohol. 

BRAYERA 

See Cusso. 

BREAST, CARCINOMA OF 

See Breast, New Growths of. 

BREASTS, CHANGES IN, IN PREGNANCY 

The breasts begin at once to prepare for their real function 
of lactation. Even as early as the second or third week 
of pregnancy the woman may be conscious of pricking 
and tingling in the breasts. From the second month there 
is usually a sense of increased fullness, followed by a visible 
increase in size. The mammary tissue at the same time 
becomes firmer and more nodular. The nipple shares in the 
enlargement and becomes more erectile and darker in 
color, and from about the fourth or fifth month a few drops 


BREAST, NEW GROWTHS OF 

of thin oily fluid—colostrum—can be expressed. This fluid 
may dry on the surface of the nipple in the form of fine 
branny scales. During the third month there is a deposit 
of pigment in the areola arouna the nipple. The depth of 
color varies from a deep pink in blonde women to a dark 
brown, almost black, in brunettes. At the same time Mont¬ 
gomery’s tubercles make their appearance. These are paler 
raised spots scattered over the areola, fifteen to twenty in 
number. They are the enlarged and pouting mouths of 
sebaceous glands. In the later months a faint secondary 
areola may be seen outside the primary areola, but it is 
marked only in very dark women. The veins of the breasts 
early become more distended and prominent, and may be 
seen as dark blue lines coursing over the breasts just under 
the skin. 

BREAST, DISEASES OF 

See Mastitis, and Nipples. 

BREAST, INFLAMMATION OF 

See Mastitis. 

BREAST, NEW GROWTHS OF 

As in other locations those tumors which invade breast 
tissue may be either benign or malignant. Of benign tumors 
of the breast, the most common are fibroadenomata; these 
occur mainly in young women; they are definitely encapsu¬ 
lated, freely movable, do not grow beyond a certain size, and 
cause no enlargement of the lymph glands of the axilla. 

Treatment. —The treatment is the excision of the growth, 
with occasional drainage of the space left by its removal for 
twenty-four hours. 

Carcinoma. —Carcinoma of the female mammary gland is 
relatively common. The rate of growth of the tumor cells 
will vary greatly. Any mass in the breast is strongly 
suspicious of carcinoma if it occurs after the age of forty, 
and is hard, not definitely encapsulated, and attached to the 
skin or deeper muscular layers. The glands in the axilla 
may be enlarged at a very early period. If the disease has 
lasted for some time the patient may be emaciated, pale, 
anemic and weak. 

Treatment. —The treatment is radical excision of the en¬ 
tire breast and the lymph glands which drain it. Inasmuch as 
some surgeons perform a rather wide excision, the skin of 
the patient should be prepared from beneath the angle of the 
jaw to the umbilicus, from well beyond the midline of the 
affected side to the region beyond the axillary border of the 


BREAST FEEDING 


scapula (shoulder blade). This preparation, in the main, 
will consist of shaving the hair. Some surgeons prefer no 
pre-operative preparation of the skin other than that of 
cleansing it with green soap and water, leaving the iodine 
to be painted on in the operating room; others will have 
the skin cleansed with green soap and water, followed by- 
alcohol, then ether, finally applying sterile dressings. 

Operation. —A sandbag is placed beneath the shoulder 
blade of the affected side. The arm may be put out either 
at right angles to the body, straight, or at right angles and 
bent at the elbow to an angle of forty-five degrees. Inas¬ 
much as many blood vessels are to be cut, there should be 
an abundance of hemostatic clamps and catgut ligatures. The 
surgeon will employ a drain, either the tube, or cigarette 
variety. After the operation, an abundance of dressing is 
applied, for there is apt to be a great amount of oozing. 
The arm, forearm, and hand, as a rule, are bond tightly to 
the chest. 

Post-operative Treatment. —As soon as the - patient re¬ 
covers consciousness, she is given a backrest, so as to sit 
almost upright in bed. As a rule, a dressing is done at the 
end of twenty-four to forty-eight hours, and ‘the drainage 
tube removed. At this dressing the arm is left free out of 
the bandage, and is held in a sling at right angles. The 
arm should be given passive movements carefully and 
gently, every two hours. The purpose of this is to diminish 
the adhesions during healing so that the scar will not limit 
the motion of the arm. 

Patients are allowed up at the end of a week, and in about 
six weeks after operation, X-ray treatment is begun. This 
is used to kill some of the cancer cells which may have 
escaped the knife of the operator. Some surgeons at the 
time of operation will expose the wound to radium for a 
certain period of time, doing the suturing later. Occasionally 
the arm may be swollen a few weeks after operation, but it 
may be lessened by massage and bandaging, although some¬ 
times, in spite of this, the arm remains large, interfering 
greatly with its movement. 

BREAST FEEDING 

See Infant Feeding. 

BREECH PRESENTATION, MANAGEMENT OF 

In some cases of breech presentation, particularly among 
primiparae, it is necessary to assist nature in the delivery 
of the child in order to save its life. Complete anesthesia 
is usually necessary at such times and the patient is preferably 
on a table or at the edge of the bed in a lithotomy position. 


BROMIDES 


In the majority of cases, no effort is made toward assistance 
until the body is born as far as the umbilicus, partly because 
of the difficulty, before that time, of taking hold of the 
child securely, and partly because the perineum is not likely 
to be fully distended; in which case, a serious tear would 
probably result. But after the body has been extruded as 
far as the umbilicus, it is usually considered imperative to 
complete the delivery within eight minutes to save the 
child from asphyxiation, due either to pressure on the cord 
between the head and pelvic brim, or to premature separation 
of the placenta. The baby’s feet or legs are grasped by a 
towel to prevent slipping, and downward traction is made 
on the body until the tips of the scapulae appear at the outlet. 
During this procedure the nurse may make pressure on the 
uterus with the idea of keeping the baby’s head flexed for¬ 
ward; this prevents the arms from getting upward above 
the head and also helps in expelling the child. 

After the scapulae appear, the arm lying posteriorly is 
brought down over the chest and delivered. The body is 
then rotated until the other arm lies posteriorly and that 
is delivered. After delivery of the arms and shoulders 
the head is usually delivered by what is known as Mauri- 
ceau’s maneuver, as follows: The accoucheur slips the index 
finger of one hand into the vaginal outlet and into the 
child’s mouth, and supports the body of the child upon his 
hand and forearm; two fingers of the other hand are slipped 
around the back of the neck and curved forward like 
hooks over the shoulders and strong downward traction is 
made by these fingers; not by the one in the baby’s mouth. 
The occiput emerges from beneath the symphysis, after 
which the body is lifted upward and the chin, nose, forehead 
and head are born. See Labor, Management of Normal. 


See Nephritis. 
See Sulphur. 


BRIGHT’S DISEASE 
BRIMSTONE 
BROILING 


See Food, Preparation of. 


BROMETONE 

Brometone is an organic bromide (acetone bromoform), 
, said not to cause cumulative symptoms. Dose 5 grains. 


BROMIDES 

The bromides are crystalline salts formed by the combina¬ 
tion of an alkali, such as potassium, sodium, ammonium, 
etc., with hydrobromic acid. 


BROMIDES 


Potassium bromide is the most active of the bromides, 
and is the preparation commonly used. 

Action after Absorption 

Action on the nervous system: The bromides lessen the 
activity of the entire nervous system: the brain, the spinal 
cord and the nerves. 

Action on the brain: The activity of the motor areas of 
the brain is lessened, so that they send out fewer im¬ 
pulses for motion. The patient then moves about slowly and 
languidly; he does not care to exert himself. Twitchings 
of the muscles and muscular contractions are lessened. 

The activity of the speech area of the brain is lessened. 
The impulses for speech are then sent out more slowly. This 
makes the speech slow, hesitating, often indistinct and its 
tone monotonous. 

The sensory areas of the brain are made less active. 

The patient then sees, hears, and feels objects less distinctly, 
and the appreciation of pain is lessened. The patient does 
not manifest much interest in the objects or activities about 
him; consciousness is lessened, and the patient becomes 
drowsy, or even falls asleep. 

The mental activities of the brain are lessened, the 

memory is indistinct, and the reasoning is poor. Ideas do 
not arise easily. All the emotions are especially lessened; 
so that a nervous, hysterical, emotional individual, often 
becomes calm and quiet. This helps to produce sleep in 
such individuals, who often suffer from sleeplessness because 
of their nervousness. 

The headache which is often produced by bromides is 
due to the strain that ordinary activities of the brain produce 
in patients under the influence of these drugs. 

Action on the spinal cord: The bromides lessen the 
activity of the spinal cord. The reflex action of the body 
is therefore lessened. The patient does not then respond 
readily to external stimuli applied to the skin or mucous 
membranes. The bromides also lessen the sexual reflexes. 

Action on the nerve endings: The bromides make the 
sensory nerve endings less sensitive. 

All the foregoing effects on the nervous system are due 
to the bromide part of the salt, and result from any bromide 
salt, such as sodium, potassium, etc. 

Action on the heart: The bromides make the heart beat 
slower and weaker, especially when it is overacting, causing 
a slow, weak pulse. This effect occurs principally from 
potassium bromide and is due largely to the potassium or 
basic part of the salt. The other bromides do not affect 
the heart as much. 


BROMIDES 


Action on the respiration: In ordinary doses the bromides 
may lessen coughing. Large doses make the breathing 
slow and shallow. 

Effect on temperature: Owing to the lessened activity of 
the various organs of the body, the temperature is slightly 
lowered, because less heat is produced. 

Poisonous Effects 

Acute poisoning from the bromides does not occur. Since 
they are rapidly absorbed, but very slowly excreted, when 
administered continually for a long time the bromides may 
accumulate in the body and cause cumulative symptoms or 
“bromism.” 


Symptoms of “Bromism” 

1. Skin eruptions. —These consist principally of groups of 
pimples on the face (acne); frequently small abscesses form 
in the skin. At other times, there are reddish spots scat¬ 
tered over the skin, and the skin may be very pale. 

2. Loss of appetite, salty taste in the mouth, bad breath, 
and disturbed digestion. 

3. Constipation. 

4. Drowsiness. 

5. Stupid, dull expression on the face. 

6. Depressed spirits, even melancholia. 

7. The eyes look heavy and dull. 

8. The patient manifests no interest in his surroundings. 

9. Slow, uncertain gait. 

10. Slow, stammering speech, often words are forgotten 
and mispronounced. 

11. Very poor memory, even recent events are forgotten. 

12. Slow pulse. 

13. Lessened reflexes (touching the conjunctiva of the 
eye does not cause winking, etc.). 

Treatment 

When the bromides are stopped, the symptoms gradually 
disappear. Giving cathartics and hot baths helps to eliminate 
the drug more easily. 

Comparative Action of Bromides 

Potassium bromide is the most active salt, but in large 
doses it may weaken the heart action and cause a slow, weak 
pulse. 

Sodium bromide is less toxic, and is a better hypnotic. 

Ammonium bromide may make the pulse and breathing 
faster. 

Lithium bromide is apt to upset the stomach. It is said to 
increase the flow of urine. 


BROMIDIA 


Uses 

The bromides are used to lessen overactivity of the brain 
in the following conditions: 

1. To prevent epileptic convulsions. 

2. To relieve the muscular twitchings of chorea (“St. 
Vitus’ dance”). 

3. To relieve emotional conditions, nervousness or excit¬ 
ability, in neurasthenia. 

4. To produce sleep when the insomnia is due to nervous¬ 
ness. 

5. To lessen sexual excitement. 

Preparations 

Potassium Bromide; dose 15 to 16 grains. 

Sodium Bromide; dose 15 to 60 grains. 

Ammonium Bromide; dose 15 to 30 grains. 

Lithium Bromide; dose 15 to 30 grains. 

Strontium Bromide; dose 30 to 60 grains. 

Calcium Bromide; dose 30 to 60 grains. 

Dilute Hydrobromic Acid; dose 30 grains to 3 drams. 

This is a 10 per cent, solution of hydrobromic acid. 

Monobromated Camphor; dose 5 to 10 grains. 

This preparation is used to lessen the excitement of 
hysteria, neurasthenia and sexual excitement. Its effect is 
due mainly to the camphor. 

BROMIDIA 

Bromidia contains potassium bromide, chloral hydrate, ex¬ 
tract of hyoscyamus, extract of cannabis indica, licorice and 
oil of orange peel. 

BROMINE 

Bromine is a liquid element obtained from sea water. 
Its action is similar to that of chlorine with the following 
differences: 

1. It is more destructive to the tissues. It is occasionally 
used to cauterize infected wounds (escharotic action). 

2. When given internally in the form of bromides it 
lessens the activity of the brain. See Bromides. 

BROMIOL OR BROMIPIN 

Bromiol or Bromipin is a combination of bromine and 
sesame oil. It usually comes either in a 10 or 33% per cent, 
solution. It is claimed that it will not cause cumulative 
symptoms. It is given in syrup flavored with peppermint 
water. Dose 20 to 150 grains. 

BROMISM 

See Bromides. 


BRONCHITIS 


BROMOCOLL 

Bromocoll contains about 20 per cent, of bromine, gelatin 
and tannic acid. Dose 30 to 60 grains. 

BROMOFORM 

Bromoform is a heavy, colorless liquid with an odor and 
taste like that of chloroform. Bromoform acts like chloral, 
but its following principal effects appear more slowly: 

1. It produces sleep. 

2. It relieves pain. 

3. It lessens spasmodic contractions of the muscles. 

4. It is an antiseptic. 

It is principally used to relieve the spasmodic cough of 
whooping cough. Dose, 3 minims. 

BROMOMANGAN 

Bromomangan is a compound of iron, manganese, bromine 
and peptones. It contains about 11 per cent, of bromine. 
It is used to soothe nervousness and to build up nervous 
patients. Dose 1 to 4 drams. 

BROMURAL 

This is an organic bromide salt (monobrom-isovaleryl 
urea), and is used to produce sleep in nervous patients. 
The sleep usually lasts for three to five hours. It usually 
comes in tablets, each containing five grains. 

BRONCHI 

The two bronchi, into which the trachea divides, differ 
slightly; the right bronchus is shorter, wider, and more 
nearly horizontal, the left bronchus is longer, narrower, and 
more nearly vertical. They enter the right and left lung, 
respectively, and then break up into a great number of 
smaller branches which are called the bronchial tubes, or 
bronchioles. The two bronchi resemble the trachea in 
structure; but as the bronchial tubes divide and subdivide 
their walls become thinner, the small plates of cartilage 
cease, the fibrous tissue disappears, and the finer tubes are 
composed of only a thin layer of muscular and elastic tissue 
lined by mucous membrane. See Trachea. 

BRONCHITIS 

Some of the first symptoms that appear in a case of 
bronchitis are chill, fever, oppressed feeling in the chest, 
irritation in the bronchial tubes, which causes paroxysms of 
coughing, aching limbs and head, and a restless, nervous con¬ 
dition of the whole body. When these symptoms appear, a 
physician should be summoned, and his directions carefully 
carried out. 


BRONCHOPNEUMONIA 


One of the important things to be watched during an 
attack of bronchitis is the temperature of the room, which 
should be kept as even as possible, and never allowed to fall 
below 68° F. A moist atmosphere is of great assistance, and 
this can be accomplished by a kettle of water kept boiling 
in the room night and day. 

Give light but nourishing food every two or three hours, 
such as milk, eggs, oysters, etc., and during convalescence 
feed the patient well. Be sure and keep the feet very warm, 
with hot water bags and bed socks, as cold feet will increase 
the tendency to cough. At the beginning of the attack a 
mustard foot-bath will be found most soothing and restful, 
and also plenty of hot drinks. 

During the first few days there is generally a paroxysm 
of coughing in the very early hours of the morning, because 
during sleep mucus is apt to collect in the bronchial tubes, 
and cause a great deal of irritation. In order to ease the 
coughing, raise the head and slip two or three pillows under 
it, give a drink of hot milk with a dessert-spoonful of 
glycerin. Inhaling steam from a kettle also gives the 
greatest relief, and it can easily be managed by surrounding 
the spout of the kettle with paper, widening it out at the 
upper end to cover the mouth completely, then forming a 
tent over the patient’s head with a sheet and letting him 
inhale the steam slowly and carefully. Mustard plasters 
relieve the oppression on the chest. 

BRONCHOPNEUMONIA 

See Pneumonia. 

BROVALOL 

Brovalol is a compound of a valeric acid salt and bromine. 
It is used to soothe nervous patients, and is said to be more 
effectual than either the valerian preparations or the bromides 
alone. Dose 4 to 12 grains. 

BROWN MIXTURE 

See Opium. 

BRUCINE 

See Nux Vomica. 

BUCHU 

This is a substance obtained from the leaves of the 
Barosma betulina and Barosma crenulata, two South Ameri¬ 
can plants. Its active principle is a stearoptene, Diosphenol, 
which is excreted in the urine and acts as an antiseptic along 
•the genito-urinary tract. It is used in the treatment of 
gonorrhea. 

Fluidextract of Bucbu; dose 30 to 60 minims. 


BURNS 


BURGUNDY 

See Alcohol. 

BURNETT’S FLUID 

See Zinc. 


BURNS AND SCALDS 

Burns and scalds are caused by the exposure of the body 
to a very high temperature of either dry or moist heat. 
Burns are caused by dry heat—a flame, hot air, hot solids, 
electricity, X-ray or radium—and by the action of corrosive 
poisons. Scalds are caused by moist heat—hot water and 
other fluids, steam or vapors. The effects produced on the 
tissues by burns and scalds are the same. 

Burns may be classified into three degrees according to 
the depth of the injury:—i, simple reddening of the skin; 
2, dermatitis with the formation of blisters; 3, actual charring, 
roasting and destruction of tissues. This may involve the 
superficial layer only or both superficial and true skin, or 
the skin, subcutaneous tissue, and muscle. 

The symptoms are both local and constitutional and vary 
with the extent and location of the injury. The local 
symptoms are heat, redness, smarting, tenderness, sometimes 
excruciating pain, swelling, and loss of function. There may 
be blisters or sloughing of the tissues. In scalds the skin 
is white, thrown into rugae and the epidermis may be detached. 
Scalds are usually more extensive than burns because absorp¬ 
tion by the clothing tends to diffuse the fluid over a larger 
area. Superficial burns are apt to be more painful than 
deep burns because burns involving the upper layers of 
skin only will leave the ends of the nerves exposed, whereas 
when all the layers are destroyed the nerves are destroyed 
with them. 

The constitutional symptoms vary with the age and condi¬ 
tion of the patient, the extent and location of the injury and 
the amount of tissue destruction They are more marked 
in burns of the chest and abdomen than of the extremities 
and are greater in children. Children, old people and 
alcoholics stand burns badly The symptoms are the symp¬ 
toms of shock, of toxemia, of meningeal irritation and con¬ 
gestion, inflammation or congestion of internal organs—the 
liver, kidneys, lungs, brain or intestines—and of acute 
nephritis. 

Shock is present in nearly all burns. It depends more 
upon the extent and location than the depth of the burn. An 
extensive, superficial burn is much more serious than a deep 
burn of limited area. A burn involving an area equal to 
one-third of the body surface is usually fatal. Shock is more 


BURNS 


apt to be fatal in burns of the chest or abdomen and in 
children, old people and alcoholics. 

Toxemia is due to the absorption of toxic products from 
the dead tissues. Later, during the period of suppuration, 
the toxemia will be caused by septic absorption. The 
symptoms are a high temperature, extreme thirst, weak, 
rapid pulse, low blood-pressure, vomiting and diarrhea. There 
may be delirium or stupor and finally convulsions or coma 
and death. 

Treatment for Burns. —As death is most frequently due to 
shock, the relief of shock should be the first consideration. 
(See Shock). 

Local Treatment .—This depends upon the extent and 
depth. When limited in extent and severity the treatment 
is rest and the application of cold wet dressings of normal 
salt solution or a saturated solution of bicarbonate of soda. 
Picric acid is frequently used. It is both antiseptic and 
astringent and promotes healing. It is not used on extensive 
burns because of the danger of absorption and poisoning, 
the symptoms of which are a yellow skin, fever, diarrhea 
and dark urine. When using picric acid care must be 
taken to protect the bed linen, etc., as it stains it yellow. 
Carron oil, which consists of linseed oil and lime-water, 
gives relief, but as it is difficult to keep the wound surgically 
“clean,” it is considered a “dirty” dressing. Soothing 
ointments, such as zinc oxide, boric, cold cream or vaseline, 
are sometimes used. The ointments used should be sterile. 

In burns of the second degree, the blisters are opened 
with sterile scissors at the lowest border and the fluid 
is allowed to escape in order to prevent infection. A wet 
dressing is then applied. 

Burns of the third degree in which the deep skin and 
with it nerve endings are exposed must be protected from 
the air (which increases the pain) and dressed as infrequently 
as possible to prevent infection and allow healing to take 
place undisturbed. Antiseptic dressings are applied. Band¬ 
ages must be put on lightly to allow for swelling. Codeine 
and morphine are given to relieve pain. 

Clothing must be removed with the greatest care—always 
cut the clothing to remove. Soak the part thoroughly with 
peroxide of hydrogen before attempting to remove the cloth¬ 
ing. See that the wound is quite clean and free from 
charred pieces of clothing. Remove the clothing very 
gradually, dressing each part as exposed—never at any time 
in applying the dressings expose a large area. 

Burns of the third degree are frequently treated with 
ambrine or a substitute consisting of a preparation of 
paraffin wax, white wax and resin cerate which melt at a 


BURNS 


low temperature. The ambrine or its substitute is melted 
over a water bath, is then poured into an atomizer, from 
which it is applied to the burned area. The wound is first 
thoroughly cleansed with boric acid or salt solution. A 
thin layer of cotton is then applied and sealed with more 
wax. This excludes air, prevents infection and supplies an 
aseptic dressing beneath which healing can take place. When 
heating the wax never bring to the boiling point, as it will 
cause it to crumble when applied. 

Burns caused by Corrosive Poisons. — The chemical sub¬ 
stances may be acids or alkalies. Burns caused by acids 
should be irrigated freely with alkaline solutions to neutralize 
the acid. Lime-water, weak ammonia or a solution of bicarbon¬ 
ate of soda may be used. Carbolic acid or creosote should 
be neutralized by alcohol or whiskey, after which a dressing 
of alcohol or a soothing ointment may be applied—oil should 
not be used as it hastens the absorption of carbolic acid. 
Burns caused by alkalies (caustic soda, caustic potash or 
ammonia, etc.) should be treated with boric acid, vinegar 
and water or lemon-juice and water. 

The systemic treatment of burns consists in the relief of 
shock, toxemia, congestion of internal organs, and nephritis. 

Shock is relieved by rest, quiet, external warmth, stimu¬ 
lants, the relief of pain and immediate attention to the 
burned area. Pain is a powerful factor in producing shock 
and must receive immediate relief—morphine is usually 
necessary. Pain must be avoided in removing clothing and 
in all subsequent dressings. 

Toxemia is relieved by the proper care of the wound— 
keeping it clean, free from infection, removing sloughing 
tissue or septic discharges and preventing their absorption; 
and by diluting the toxic products and flushing them out 
of the system—by forced fluids by mouth, rectum or hypo- 
dermoclysis, by keeping the bowels open with cathartics 
and increasing the elimination by the kidneys. 

Meningeal irritation with headache, delirium and restless¬ 
ness, etc., is relieved by an ice-cap applied to the head and 
the administration of sedatives, usually bromides. 

Congestion of internal organs may be prevented by the 
application of cold compresses or the ice-coil. Turning the 
patient frequently, and steam inhalations to soothe the irritated 
mucous membrane of the respiratory tract will help to prevent 
pneumonia. Liquid diet and keeping the intestines free from 
irritating matter will help to prevent intestinal inflammation. 

Acute nephritis may be prevented or relieved by lessening 
the work of the kidneys and aiding them in eliminating the 
waste and poisonous products. Their work is lessened by 
limiting the diet to milk and other fluids and by increasing 


BURNS OF ESOPHAGUS 


the elimination by the intestines, also by preventing the 
absorption of toxic and septic products. Eliminations are 
aided by forced fluids, lemonade, Imperial drink and other 
diuretics. 

Local Complications of Burns. —The burned area may be¬ 
come infected with pyogenic organisms commonly found in 
the skin. This may result in suppuration and general 
toxemia from the absorption of septic products or septicemia 
from the invasion of the blood stream by bacteria. Infection 
by the streptococcus pyogenes or erysipelatis causing erysipelas 
may occur, particularly in burns about the face. Extensive 
sloughing of the tissues may lead to a secondary hemorrhage. 
Embolism may occur from the entrance of tissue cells into 
the blood stream. Contraction of the tissues in healing may 
occur with an unsightly scar and, if near a joint, stiffness and 
limited motion. 

BURNS OF ESOPHAGUS 

See Esophagus. 

BURROW’S SOLUTION 

See Alum. 

BUTYL CHLORAL HYDRATE 

See Croton Chloral Hydrate. 


c 


CACHETS 

Cachets are small disc-like pieces of rice paper which 
are stuck together, enclosing between them the drug to be 
administered. 


CADE, OIL OF 

This is a substance made by destructive distillation of 
Juniper wood. It is used as an antiseptic and irritant in 
skin diseases. 

CAFFEINE 

Caffeine is a white crystalline powder, the active alkaloid 
of the coffee bean, Coffea arabica. It is also found in tea 
leaves, thea chinensis of China; in Paraguay tea of Argen¬ 
tine and in the kola nut of Central Africa and the guarana 
paste of Brazil. 

Coffee causes the same effects as caffeine, for the action 
of coffee is due principally to the caffeine which it contains. 

Coffee and tea are very commonly used beverages. They 
are infusions of the coffee bean or of tea leaves. The 
eoffee bean contains about % per cent, of caffeine. A cup 
of coffee contains about one to three grains of caffeine. 

Coffee has a laxative effect because of volatile oils which it 
contains. 

Tea contains about i l /t to 2 per cent, of caffeine. A 
cup of tea also contains one to three grains of caffeine. 

Tea contains a large amount of tannic acid, which contracts 
mucous membranes (astringent action). 

Appearance of the patient. —When a patient is given an 
average dose of caffeine, or when a strong cup of coffee is 
taken, the following effects are noticed: 

The patient is more wakeful, brighter, and is able to 

think more quickly and better, and to reason better. In 

fact, all mental work can be done better and with less 
fatigue. The patient is more active and responds more 
easily, more rapidly and better, to all influences about him. 
The pulse is quicker and may be stronger, and the breathing 


CAFFEINE 


is deeper and more frequent. The patient also urinates more 
frequently and passes more urine. 

Caffeine is an ideal stimulant, because it increases the 
activity of almost every organ of the body. Its effects 
appear in about a half to one hour after it is given, and 
last only for one or two hours. 

Internal Action 

In the mouth: Caffeine has a slightly bitter taste. 

In the stomach and intestines: Caffeine produces no ef¬ 
fects. Coffee, however, because of a number of volatile 
oils which it contains, increases the peristalsis, causing mild 
movements of the bowels. 

Excretion 

Caffeine is excreted mainly by the kidneys in a few hours. 
Very little caffeine is excreted as such. Most of it is 
changed to urea, a normal constituent of urine. 

Poisonous Effects 

Acute caffeine poisoning is very rare, because the caffeine 
is excreted very rapidly. The following symptoms were 
present in a few cases that have occurred: 

1. Headache. 

2. Confusion. 

3. Noises in the ear. 

4. Flashes of light. 

5. Delirium. 

6. Palpitation of the heart. 

7. Rapid, weak pulse. 

8. Short, quick breathing. 

9. Convulsive movements of the hands and tremors of 
various parts of the body. 

10. Profuse flow of urine. 

11. Collapse (pallor, cold, moist skin, rapid, thready pulse, 
slow and shallow breathing, cold extremities). 

Chronic Caffeine Poisoning—“Coffee Habit” 

This occurs particularly in people who drink strong coffee 
habitually. The patient is very nervous, is easily excited 
and disturbed even by the slightest noise. He is unable 
to sleep, complains of headache, palpitation of the heart and 
twitching of the fingers and hands. The pulse may be rapid 
and irregular. 

When the patient stops drinking coffee, all these symptoms 
disappear. 

Administration 

Caffeine is given in capsules, tablets or powders. It 
should be given well diluted in water. Since its effects appear 


CALCIUM 


rapidly and soon pass off, it is better to give small doses, 
frequently repeated, than a single large dose. When the 
effect of one dose wears off, there is more caffeine in the 
body to produce its effects. 


Uses 

Caffeine is one of the best stimulants for collapse. The 
effect is due to the stimulation of the brain, the breathing 
and to the contraction of the blood vessels. It is also 
an excellent diuretic. In heart weakness, in the course 
of infectious diseases, caffeine is a valuable drug, be¬ 
cause of the general stimulation of the patient and the con¬ 
traction of the usually dilated blood vessels. 

Preparations 

Caffeine; dose i to 5 grams. 

Citrated Caffeine; dose 1 to 8 grains. 

Effervescent Citrated Caffeine; dose one dram. 

This is a mixture of citrated caffeine, sodium bicarbonate, 
tartaric acid and sugar, containing 4 per cent, of citrated 
caffeine. It effervesces when dissolved in water. 

Caffeine Sodium Benzoate; dose 1 to 5 grains. 

This is an excellent preparation for hypodermic use. 

It is usually kept in 25 per cent, stock solutions. 

CALCIUM OR CALX (LIME) 

Calcium salts are found very abundantly in nature. 
They are found in large quantities in all the tissues of 
animals. Calcium phosphate is found in the bones and 
teeth of all animals, as well as in many of the soft tissues. 
Calcium salts are necessary for the activity of many forms 
of living matter. 

Local action: The calcium salts have no effect on the 
skin. 

Calx or unslaked lime, however, burns and destroys tissues 
if applied to mucous membranes. 

Internal Action 

In the mouth: The calcium salts contract the mucous 
membranes. 

In the stomach: They neutralize the acid, lessen digestion 
and contract and soothe the mucous membranes. 

In the intestines: They contract and soothe the mucous 
membrane (astringent action). 

Action after Absorption 

The calcium salts are very slowly absorbed from the 
stomach and intestines. Part of' these salts are absorbed 


CALCIUM 


into the blood, however, and help to form fibrin ferment, 
so that the blood clots better. 

In diseases where there is an insufficient amount of calcium 
or lime in the body, such as rickets, the bones become 
softened and are often deformed. The calcium absorbed 
from the blood is then deposited in the bones and hardens 
them. 

Calcium is also necessary for the nutrition of nerve tissues. 
Many nervous conditions characterized by twitching of the 
muscles are believed to be due to a deficiency of calcium 
in the body. 

Excretion 

The calcium salts are excreted mostly by the large intes¬ 
tine and kidneys. 

Poisonous Effects 

Poisoning from lime occasionally occurs when unslaked 
lime is swallowed. The symptoms are the same as those 
of poisoning by other alkalies. 

Slaked lime occasionally causes severe destruction of the 
tissues. Laborers who handle lime occasionally get some of 
it into the eye. When this happens the eye should immedi¬ 
ately be thoroughly washed out with a solution of boric acid. 
Destruction of the eye, or loss of sight, may result. 

Uses 

Solutions of calcium are used locally to soothe the skin in 
burns. Internally, calcium is used to neutralize the acid in 
the stomach, in hyperacidity, to lessen nausea and vomiting, 
and in ulcer of the stomach. 

When given to neutralize the acid, it is best given about 
a half to one hour after meals, when the stomach contains 
the largest amount of acid. Calcium preparations are also 
used as antidotes for poisoning by acids. 

Calcium salts are frequently given in nervous conditions 
characterized by excitability, such as epilepsy, tetany, etc. 

Preparations for Internal Use 

Lime-Water, Solution of Calcium Hydrate (Liquor 
Calcis) ; dose i to 4 ounces. 

This is a saturated solution of calcium hydrate or slaked 
lime, containing to M of a grain of calcium hydrate to 
one ounce of water. 

It is made by washing slaked lime with distilled water, 
and then filtering the resulting solution. 

It is used to neutralize the acid in the stomach, to soothe 
the stomach and to lessen nausea and vomiting. It is very 
constipating. 


CALORIES 


When added to milk, it lessens curdling in the stomach 
and makes the milk more digestible. 

Syrup of Lime, Syrup of Calcium Hydroxide (Syrupus 
Calcis) ; dose 15 to 60 minims. 

This contains 5 per cent, of lime. 

Calcium Chloride; dose 5 to 15 grains, well diluted. 

This is used to increase the clotting of the blood. It is 
somewhat injurious to the tissues however. When fresh it 
is a good antiseptic, 6 ounces of the calcium chloride being 
used to a gallon of water. 

Calcium Lactate; dose 3 to 10 grains. 

This is used principally to increase the clotting of the 
blood in hemorrhage. It is frequently given for several 
days before tonsil and adenoid operations to prevent profuse 
bleeding. It is occasionally given hypodermically. 

For Local Use 

Lime Liniment (Linimentum Calcis), Carron Oil. —This 
is a mixture of equal parts of lime-water and olive or 
linseed oil. 

Unslaked Lime, Calx. —This is made from limestone. It 
forms a white mass which cracks and changes to a powder, 
when placed in water, forming slaked lime and liberating 
heat. 

It is used as a disinfectant and to destroy tissue (caustic). 

For this purpose it is used together with potassium in the 
form of Vienna paste or potassa cum calce. 

Milk and Lime, Whitewash. —This is made by adding 1 
part of slaked lime to 4 parts of water. It is used as a 
disinfectant, especially for typhoid and cholera stools. It 
is also a soothing application for burns. 

Chalk Mixture (Mistura Cretae) ; dose half to one ounce. 
This contains 2.0 grams chalk suspended in 30.0 grams water 
by means of gums. 

CALOMEL 

See Mercury. 

CALORIES 

The heat of the body, like that from the burning or com¬ 
bustion of coal in a furnace, is the result of the oxidation 
or combustion of food, chiefly carbohydrates and fats, but 
also proteins, in the body. These foods if burned in a 
furnace would likewise produce heat. As we only eat to 
live and as this production of heat in the body is so vital, 
the value of food to the body is reckoned in terms of 
calories, a calorie being the amount of heat necessary to 
raise one gram of water one degree Centigrade in tempera¬ 
ture. One large calorie (C) is the quantity of heat necessary 


CALX 


to raise the temperature of 1000 grams of water one degree. 
Thus the values of the foods are as follows (Howell): 

I gram protein (heat value) = 4100 calories (4.1 C.) 

1 gram carbohydrate (starch) =4100 calories (4.1 C.) 

1 gram fat = 93°5 calories (9.3 C.) 

These figures therefore represent the amount of energy 
(either in the form of heat or mechanical work) these foods 
are capable of supplying to the body. In this way the heat 
or energy value of any given diet may be estimated. See 
Food. 

CALX 

See Calcium. 

CAMPHOR 

Camphor is obtained from the Laurus camphora or Cinna- 
momum camphora, an evergreen found in China and Japan. 

Appearance of the Patient 

About a half to one hour after an ordinary dose of 
camphor is given, the patient becomes calm and quiet, though 
somewhat exhilarated. He has a feeling of warmth in the 
stomach. The pulse may be stronger, but the rate may be 
slow or fast and the patient breathes faster and easier. 
When it is given hypodermically, these effects appear sooner. 

Local action: Applied to the skin, camphor causes red¬ 
ness and a feeling of warmth. It relieves pain at the spot 
where it is applied, and is slightly antiseptic. 

On mucous membranes: It causes slight contraction and 
is antiseptic. 

Internal Action.—In the mouth: Camphor has a hot, 

bitter taste. 

In the stomach: It causes a feeling of warmth, checks the 
formation, and hastens the expulsion of gas (carminative 
action). 

In the intestines: It often checks diarrhea and aids in 
the expulsion of gas. 

Action after Absorption 

Camphor is absorbed from the stomach in a few hours. 
After absorption it affects principally the heart, the respira¬ 
tion, the brain and the secretions. 

Action on the heart: Camphor may make the heart beat 
stronger. The rate may be faster or slower. Frequently 
camphor has no effect on the heart at all. 

The blood vessels are widened, however, and the pulse 
may have a bounding quality and be either slow or fast. 

Action on the respiration: Camphor makes the patient 
breathe faster and deeper. This action is not always marked. 


CAMPHOR 


Action on the brain: In the doses that camphor is usually 
given, it makes the patient feel calm and quiet, though 
somewhat exhilarated. This is due to increasing the con¬ 
trolling or inhibitory influences over the impulses usually 
sent out from the brain. In larger doses the action of the 
brain is increased. The patient then becomes more active 
and more talkative. 

In poisonous doses, the action of the entire brain is increased, 
the brain sending out so many impulses, for motion, speech, 
etc., that convulsions and delirium may occur. 

Action on secretions: Camphor slightly increases the 
secretions, especially the sweat and mucus. 

Excretion 

Part of the camphor is used up by the tissues of the 
body. The rest is eliminated in a few hours by the kidneys, 
sweat and feces. 


Poisonous Effects 

Overdoses of camphor produce the following symptoms, 
though they are rarely fatal: 

1. Burning pain in the stomach. 

2. Headache. 

3. Dizziness. 

4. Delirium. 

5. Convulsions. 

6. Weakness in the extremities. 

7. Weak, small pulse, rapid or slow. 

8. Pale, cold, moist skin. 

These symptoms disappear when the drug is stopped. 

Uses 

Preparations of camphor such as the liniment, are used to 
relieve pain, in sprains or muscular rheumatism. 

It is used as a heart stimulant, and often to lessen nerv¬ 
ousness. 

Recently, pneumonia has been treated by repeated intra¬ 
muscular injections of 2V2 dram doses of camphor oil. 

This treatment is based upon the fact that camphor checks 
the growth of the Pneumococcus, the bacterium which causes 
pneumonia. It is then supposed to act as a specific in 
pneumonia, and at the same time to strengthen the heart 
action. 


Preparations 

Camphor; dose 2 to 10 grains. 

Monobromated Camphor; dose 5 to 15 grains. 


CANCER 


This is occasionally used to relieve nervousness, hysteria, 
and sexual excitement. 

Camphor Water (Strength 1-125); dose 15 to 60 minims. 

Spirit of Camphor (Strength 10 per cent.); dose 5 to 30 
minims. 

This is much stronger than the camphor water. 

Camphor Oil; dose 5 to 10 minims. 

This is the crude oil itself and rarely used. 

Camphor Liniment or Camphorated Oil; dose 30 minims. 

This is a 20 per cent, solution of camphor in cottonseed 
oil. It is used locally to relieve pain. 

It is extensively used, however, for hypodermic use as a 
heart stimulant; and in doses of 10 c.c. in the treatment of 
pneumonia. It should always be injected deeply into the 
muscles. 

Soap Liniment. —This contains about 5 per cent, of cam¬ 
phor, 6 per cent, of soap, 70 per cent, of alcohol, and oil of 
rosemary. It is used locally to relieve pain. 

CANCER 

See Breast, Stomach, Uterus. 

CANNABIS INDICA (INDIAN HEMP) 

Cannabis indica is a resinous substance obtained from the 
flowers of the Cannabis sativa or Indian hemp, a plant 
growing in India, Egypt, and the southern part of the United 
States. 

It is used as an intoxicant in various forms in most of the 
Eastern countries. In India, the dried plant is used for 
smoking, either alone or with tobacco, and is called gunjah 
or bhang. Churrhus or hashish is an intoxicating drink 
containing the resinous juice, which is used in Arabia and 
Egypt. The active principle of cannabis indica is said to be 
a red oil or resin called cannabinol. 

Appearance of the Patient 

About a half to one hour after giving an average dose of 
a reliable preparation of cannabis indica, the patient feels 
drowsy, the sense of pain is lessened, the extremities feel 
numb, the patient often complains of noises in the ear, and 
he soon falls into a deep sleep, lasting several hours, from 
which he usually awakes refreshed. During the sleep, he 
may have particularly vivid, beautiful dreams. The pulse 
and breathing are normal and the pupils are dilated. 
Occasionally he may be somewhat exhilarated before falling 
asleep. 

Internal Action. —When given internally it has a peculiar 
taste. It produces no effect in the stomach and the intestines, 


CANTHARIDES 


but is rapidly absorbed into the blood from the stomach, and 
it then acts principally on the brain. 

Action on the brain: Cannabis indica lessens the apprecia¬ 
tion of the various sensations, such as pain, touch, etc. In 
this way, it relieves pain and produces sleep. 

It lessens the higher intellectual functions such as reason¬ 
ing and judgment and also the sensory areas of the brain, 
while increasing the imagination. This accounts for the 
relief from pain and the characteristic vivid dreams. It 
dilates the pupil. 


Effects of Large Doses 

When cannabis indica is taken in large doses, or when it 
is smoked, it usually produces a characteristic state of pleasure 
and exhilaration which accounts for its frequent use as an 
intoxicant. During this state of exhilaration, ideas arise 
so rapidly, that time seems to pass much faster than it 

actually does. Events which usually last hours seem to 
occur in several minutes. This state of exhilaration lasts 
for a short time, perhaps an hour, and the patient then 

falls into a normal, quiet sleep from which he can be readily 
awakened. Often the individual has a sense of impending 
death. 

The pulse is perhaps a little stronger and faster, the breath¬ 
ing is normal, and the pupils are dilated. 

Uses 

Cannabis indica is used to relieve pain and to produce 

sleep as a substitute for morphine, in neuralgia, painful 

menstruation, chorea, hysteria, etc. It is an unreliable 
drug, however, as many of its preparations are inactive. 
Preparations made from plants grown in warm climates are 
usually better. 


Preparations 

Extract of Cannabis Indica; dose V* to i grain. 

Fluidextract of Cannabis Indica; dose 2 to s minims. 

Tincture of Cannabis Indica; dose 15 to 30 minims. 

CANTHARIDES 

Cantharides or Spanish flies are dried beetles found in 
various temperate climates, especially in Spain and Italy. 
The active principle is a neutral substance, cantharidin. 

Applied to the skin: there is produced redness and swell¬ 
ing with the formation of a blister. Internally, in small 
doses there is an increase in the flow of urine; sexual desire 
is said to be increased. 


CAPILLARY BLEEDING 


Poisonous Effects 

Absorption of cantharides from the skin, or when taken 
internally in large doses, produces the following symptoms, 
which are due to the injury of the kidneys and alimentary 
tract. 

1. Profuse vomiting and diarrhea. 

2. Painful, scanty urination, with scanty urine, which 
often contains blood. 

3. Delirium, convulsions and collapse. 

If it is taken in solution it causes blisters in the mouth 
and esophagus, which often prevent swallowing. 

The symptoms are best relieved by washing out the stomach, 
the administration of opium for the pain, and giving demul¬ 
cent drinks. 

Preparations 

Cerate of Cantharides. 

Cantharides Collodion. 

Tincture of Cantharides; dose 2 to 5 minims. 

Cantharides is frequently applied in the form of a plaster: 
a small piece of the plaster, the size of a dime, is applied 
over the affected area. 

Before applying cantharides, the skin should be shaved, 
cleansed with soap and water, alcohol and ether. The 
plaster is then applied and left on for about 4 to 8 hours, 
depending upon the effect desired. 

CAPILLARY BLEEDING 

See Hemorrhage. 


CAPSICUM 

Capsicum, or Cayenne Pepper, is the extremely pungent 
fruit of the Capsicum fastigiatum, or African pepper. 

Capsicum causes marked redness and blistering of the 
skin, often destruction of the area of skin over which it is 
applied. 

In large doses it often causes violent pain in the abdomen, 
with vomiting, followed by profuse diarrhea and very painful 
urination. 

Uses. —Capsicum is used to increase the secretion of the 
stomach, particularly in patients suffering from chronic 
alcoholism. In such patients the lining membrane of the 
stomach is so affected that it secretes very little gastric 
juice. 

It is also used in the form of a plaster to produce blisters, 
in order to draw fluid from deeper tissues into the skin. 

Tincture of Capsicum; dose 30 to 60 minims. 

Capsicum Plaster (Emplastrum Capsici). For local use. 


CAPUT SUCCEDANEUM 


CAPSULES 

Capsules are drugs made up into a small cylindrical gelatin 
container which disguises the taste of the contained substance. 

CAPUT SUCCEDANEUM 

During labor the part of the scalp which lies within the 
circle of the girdle of contact of the soft passages becomes 
the seat of a swelling. This is because it is exposed to less 
pressure than the surrounding areas of scalp which are 
pressed on by the soft passages. The swelling is a sero- 
sanguineous infiltration into the connective tissues of the 
scalp, and the position of this so-called caput succedaneum 
varies according to the position of the head. In occipito¬ 
anterior positions the presenting part in the early stages of 
labor is the vertex. Therefore the caput first forms on the 
vortex—on the right of the sagittal suture in L.O.A., and 
on the left in R.O.A. cases. As labor proceeds and flexion 
becomes more pronounced, the posterior fontanelle becomes 



Section showing structure of caput succedaneum. 

(From Johnstone’s Textbook of Midwifery) 
the presenting part, hence the caput succedaneum is ulti¬ 
mately found in that region, a little to the right or left as 
before. It may therefore be said that in L.O.A. cases it is 
on the upper posterior angle of the right parietal bone, 
and in R.O.A. cases on the corresponding angle of the left 
parietal. The appearance of the caput is generally red and 
congested. The longer the labor lasts, the larger does the 
caput tend to become, and in some cases it may so obscure 
the landmarks of the head as to render the diagnosis of the 
presentation and position a matter of some difficulty. 

The caput succedaneum begins to disappear immediately 
after birth, and has usually quite vanished after twenty-four 
hours. 












CARBOLIC ACID 


CARBOLIC ACID (PHENOL) 

Carbolic acid or phenol is a crystalline solid substance 
which readily absorbs moisture from the air. It is made 
by distilling coal tar; it dissolves readily in water, alcohol 
or glycerin. 

Antiseptic Action 

Carbolic acid destroys all living tissues (protoplasm). 
In weak solutions (2 to 5 per cent.) it checks the growth 
of all bacteria except their spores. It is the most efficient 
antiseptic known. 

Action on the Body 

Local action: Concentrated solutions destroy the skin by 
hardening or coagulating the proteins of the cells. This 
forms a white crust which becomes red and shiny. The 
crust falls off in a few days, leaving a light brown area. 
Weak solutions (2 to 5 per cent.) produce a feeling of 
warmth and tingling followed by numbness and contraction 
of the skin. Applied to wounds, carbolic acid causes pain 
and redness with the formation of a white pellicle of 
coagulated albumen. 

Local applications of carbolic acid solutions, if prevented 
from evaporating, as when applied in the form of a wet 
dressing, often destroy the skin and deeper tissues (gan¬ 
grene). Gangrene of a finger or other part of the body 
has resulted from continued use of such wet dressings. For 
this reason its use as a wet dressing has been given up. On 
mucous membranes: carbolic acid checks the growth of 
bacteria if applied in weak solutions. 

Strong solutions, if applied for some time, destroy the 
tissues; and if the area over which it is applied is extensive, 
collapse may result. 

Internal Action 

Carbolic acid is never given internally. 

Action after Absorption 

When a small quantity of carbolic acid is absorbed, either 
from wet dressings applied to wounds or when formed 
in the intestine, it occasionally produces the following 
effects: 

1. It increases the secretion of saliva. 

2. It increases the flow of urine. The urine has a 
characteristic smoky dark green color which soon turns 
brown or even black. 

3. Occasionally, the patient becomes somewhat drowsy, 
due to the lessened action of the brain. 


CARBOLIC ACID 


4. The breathing becomes somewhat deeper and faster 
and the pulse slower and weaker. 

Excretion 

In cases where a small quantity of carbolic acid is absorbed, 
it is rapidly eliminated by the urine in the form of various 
compounds which give the urine a characteristic dark green 
color. 

Poisonous Effects 

Acute poisoning from carbolic acid is not an infrequent 
occurrence as a result of attempts at suicide, since it is the 
easiest poison to obtain. 

Symptoms. —If a large quantity of carbolic acid is taken, 
the patient becomes unconscious and dies within a few 
minutes from a sudden paralysis of the heart and respiration. 
This is probably due to the sudden destruction of a large 
area of mucous membrane and the resulting collapse. 

If smaller quantities are taken, the following symptoms 
appear in the order of their onset. Some of these symp¬ 
toms also occasionally result from the continued use of wet 
dressings: 

1. Pain around the mouth and lips, and in the stomach. 
The lips and mouth are blanched. 

2. Nausea and vomiting, the vomited matter containing 
mucus. 

3. Headache, dizziness, and noises in the ears. 

4. Drowsiness and depression. 

5. Collapse: rapid, thready pulse, cold, moist skin, the 
pulse falls to 40 or 50 per minute, the breathing becomes 
irregular, often snoring in character. Toward the end, the 
breathing becomes difficult and shallow, sometimes gasping, 
and because of the shallow breathing the patient becomes 
cyanotic. 

6. Finally, the patient goes into stupor, and coma, and 
may die from paralysis of the respiration, in about one to 
ten hours. 

Occasionally, convulsions occur just before death. A very 
characteristic symptom of carbolic acid poisoning is the 
dark green color of the urine, and the odor of the acid on 
the breath. The fatal dose is usually about 1 to 4 drams. 

Treatment. —1. Wash out the stomach with 20 per cent, 
alcohol. 

2. The following salts are given as antidotes: about one 
ounce of one of the salts dissolved in a glass of water. 

Magnesium sulphate (Epsom salts). 

Sodium sulphate (Glauber’s salts). 

Lime-water and milk. 

They form sulphocarbolates, harmless salts of carbolic acid. 


CARBON MONOXIDE 

3. Give alcohol in the form of whiskey or brandy, or 
even in 20 per cent, solutions. The alcohol neutralizes the 
carbolic acid; its mode of action is unknown. (A carbolic 
acid burn is readily neutralized, if followed immediately 
by the application of alcohol.) The stomach should be 
washed out, however, as the solution is readily absorbed. 

4. Protect the mucous membrane of the mouth and 
esophagus with albumen water, flaxseed tea or milk. Do 
not give oils or glycerin as they help to absorb the carbolic 
acid. 

5. The collapse is treated with heart stimulants such as 
caffeine, strychnine, atropine, etc., and the patient should 
be kept warm. 

Uses 

Carbolic acid is used: 

1. To disinfect sinks, toilets, sputum cups, clothing, etc., 
in 2 to 5 per cent, solutions. The articles must be soaked 
in carbolic acid for a half to several hours. 

2. To disinfect the sick room by washing the walls and 
furniture. The fumes are often inhaled from such use and 
cause slight poisonous symptoms. 

3. It is occasionally given internally to check vomiting, 
and as an intestinal antiseptic to check fermentation in the 
intestines. 

Preparations 

Carbolic Acid (Phenol): for internal use; dose % to 3 
grains. 

This comes in crystals which readily take up water 
(hygroscopic). It is used principally for its destructive 
action on tissues (corrosive action). 

Liquid Carbolic Acid (Phenol Liquefactum) ; for internal 
use; dose 1 to 3 minims. 

This contains 90 per cent, of carbolic acid. 

Glycerite of Phenol; dose 2 to s minims. 

This contains 20 per cent, of phenol dissolved in glycerin. 

Carbolic Acid Ointment (Unguentum Phenolis). 

This contains 5 per cent, of carbolic acid. 

As an antiseptic carbolic acid is used in 2 to 5 per cent, 
solutions. 

CARBON MONOXIDE POISONING 

This is recognized by the great difficulty with which these 
patients breathe, the fact that their lips are a very deep red 
and their skin a bluish hue. The condition requires urgent 
interfernce. 

Treatment. —The blood must be rid of the excess carbon 
monoxide and its oxygen content increased. The patient may 


CASTOR OIL 


be given oxygen from a commercial oxygen tank by means 
of a funnel held directly over the nose and mouth. To 
prevent further loss of oxygen, a paper cornucopia may be 
fastened to the funnel. If the congestion of the patient is 
very extreme, blood may be removed from a vein in the 
arm. This reduces the actual blood content of carbon 
monoxide, and then the patient may be given an infusion 
of saline or a transfusion of blood which will still further 
decrease the amount of poisonous gas. 

CARCINOMA OF BREAST 

See Breast, New Growths of. 

CARDAMOMUM 

Cardamom is a drug obtained from the fruit of the Elet- 
taria repens, which grows in the East Indies. It is used as a 
carminative. 

Tincture of Cardamomum (2 per cent.); dose 1 dram. 

Compound Tincture of Cardamom; dose 1 to 2 drams. 

CARMINATIVES 

Carminatives are drugs which produce a feeling of com¬ 
fort in the stomach and relieve the formation of gas in 
the stomach and the intestines. They also increase the 
appetite. The chief carminatives are capsicum, ginger, 
cardamom and asafetida. 

CARRIERS 

See Infectious Diseases, Course of. 

CARRON OIL 

See Calcium. 

CASCARA 

Cascara sagrada is obtained from the bark of the California 
buckthorn. Its official name is Rhamnus purshiana. It 
acts on the large intestine and is one of the best laxatives. 
It is usually given at night, and produces a normal stool 
the next morning without griping. It is often given for 
habitual constipation. 

Preparations 

Extract of Cascara Sagrada; dose 4 grains. 

Fluidextract of Cascara Sagrada; dose 15 minims. 

CASTOR OIL—OLEUM RICINT 

Castor oil is a fixed oil (an oil which does not evaporate), 
obtained from the seeds of the Ricinus communis, a tree 


CATALEPSY 


growing in all warm countries. Castor oil has no odor, but 
a very unpleasant, nauseating taste. 

Local Action: On the skin and mucous membranes, 
castor oil is very soothing. 

Internal Action 

In the mouth: It has an unpleasant, nauseating taste. 
Even its smell will sometimes produce nausea. 

In the intestines: Castor oil produces frequent move¬ 
ments of the bowels in about three to six hours, not accom¬ 
panied by griping. The stools are soft, but after the move¬ 
ments have occurred, the bowels are apt to be constipated. 
Because it is eliminated in the milk, castor oil often acts 
as a laxative on nursing infants. 

Castor oil is one of the best carthartics for temporary 
use, because of its soothing after-effect which produces 
constipation. 

Preparations 

The dose for an adult is to i ounce; for an infant i to 
2 drams. 

Laxol is a tasteless preparation of castor oil. 

Administration 

In giving castor oil the unpleasant taste must be disguised. 
Castor oil should always be given cold, as the taste is then 
not as readily appreciated. This may be done in the follow¬ 
ing ways: 

1. By giving the oil in an equal part of glycerin or brandy. 

2. By making an emulsion of the oil by pouring it into 
flavored soda water, sarsaparilla or grape juice. 

3. The patient’s mouth may be rinsed out with a little 
whiskey or peppermint, before giving the castor oil. 

4. It may be poured between two layers of lemon juice, 
grape juice, orange juice, or whiskey. 

CATALEPSY 

See Suggestibility. 

CATAPLASM 

See Poultices. 

CATECHU 

Catachu is an extract prepared from the wood of Acacia 
catechu, an East Indian plant. It is a powerful astringent 
because of the tannic acid which it contains. It is not 

often used. 


CATHARTICS 


Preparations 

Tincture of Catechu; dose 30 to 60 minims. 

Troches of Catechu, each contains one grain. 

Compound. Catechu Powder; dose 10 to 30 grains. 

This contains catechu, kino, krameria, cinnamon and nut¬ 
meg. See Gambir. 

CATHARTICS 

Cathartics are drugs which are used to move the bowels 

Classification 

Cathartics may be divided into the following three classes, 
depending upon whether they cause mild action, moderate 
action, or more violent action: 

1 . Laxatives or Aperients 

2. Purgatives (Simple and Saline) 

3 . Drastic Purgatives 

1. Laxatives or aperients are medicines which cause a 
few movements of the bowels. The stools are formed, 
normal in character, and the movements are not accom¬ 
panied by griping. 

2. Purgatives are drugs which produce frequent move¬ 
ments of the bowels, with soft stools accompanied by griping. 

There are two kinds of purgatives: Simple and Saline. 

1. Simple purgatives are plant or other substances which 
cause frequent movements of the bowels. 

2. Saline purgatives are inorganic (mineral) salts used as 
purgatives. These are often called hydragogue cathartics 
because they produce very frequent watery stools. 

Many purgatives are also called cholagogue cathartics 
because the stools resulting from their use are highly colored 
with bile. 

3. Drastic cathartics are drugs which cause frequent fluid 
movements of the bowels, accompanied by severe griping 
pains. Drastic cathartics should not be given to very young 
or to very old patients. In pregnant women they may 
induce abortion. Drastics may cause nausea, vomiting, ab¬ 
dominal pain and profuse diarrhea. As a result of these 
symptoms, there is usually severe collapse: the skin is pale, 
moist and cold, the breathing is slow and shallow, the pulse 
is rapid, thready and weak, the pupils are widely dilated, and 
the patient finally goes into coma and may die. 

Administration 

Cathartics which produce mild effects, or which produce 
their effects slowly, should be given at night. Those which 
produce rapid effects should be given in the morning. 


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CATHARTIC PILLS 


Cathartics should never be given after meals as they may 
cause vomiting. 

Cathartics which cause violent action should not be given 
in cases where the intestine is diseased (for example—in 

typhoid fever or acute appendicitis). 

In cases that have had an abdominal operation per¬ 
formed upon them, the nurse should never administer a 
cathartic without the doctor’s order. 


CATHARTIC PILLS 
Compound Cathartic Pills 
(Pilulae Catharticae Compositae) 

This is very frequently used. Each pill consists of: 
Compound Extract of Colocynth grains 

Calomel i grain 

Resin of Jalap % of a grain 

Gamboge V\ of a grain 

i pill is given for a purgative, 3 pills for a drastic effect. 


Vegetable Cathartic Pills 
(Pilulae Catharticae Vegetables)' 

Compound Extract of Colocynth 1 grain 
Extract of Hyoscyamus grain 

Resin of Jalap % of a grain 

Extract of Leptandra % of a. grain 

Resin of Podophyllum of a grain 

and about one minim of oil of peppermint for every hundred 
pills. 

The peppermint and the hyoscyamus lessen the griping. 


CATHETERIZATION 

Conditions in which Catheterization is Resorted to.— 

1. Retention of urine .—This may be due to a temporary 
paralysis following an anesthesia, to dulled senses following 
the use of drugs such as alcohol and morphine, etc., to 
paralysis, to shock, to operations on the pelvic organs or on 
the rectum or anus which are supplied by the same nerves, 
to loss of tone in the muscles of the bladder or to a nervous 
contraction of the urethra. 

2. Retention with overflow .—In this condition there is 
voluntary or involuntary micturition, in small, frequent 
amounts, which does not relieve the bladder. The bladder 
is distended and can easily be seen or felt and the patient 
is in constant distress, obtaining no relief from voiding. 

3. Involuntary micturition .—This may occur when the 


CATHETERIZATION 


patient is in a stupor or coma or may result from injuries to 
the spine or after an operation such as a prostatectomy. 

4. Catheterization as an aid to diagnosis. 

5. Catheterization to prevent infection of a wound. —It is 
a rule, with some surgeons, to have a patient catheterized 
every eight to twelve hours following an operation on the 
perineum or external genitals, etc., to keep the stitches dry , 
and the wound free from infection until it is healed suffi¬ 
ciently to be no longer in danger. Other surgeons feel that, 
if the parts are kept clean, particularly after the use of the 
bedpan, the urine will do little harm, whereas frequent 
catheterization may do considerable harm. 

Dangers Involved in Catheterization. —Even when this 
treatment is given with the greatest care, aseptic precautions, 
and skill, there is considerable risk of the patient developing 
cystitis as a result. This is particularly true when the 
treatment must be repeated over a period of days or weeks, 
or when the patient’s general weakened condition predisposes 
to infection. 

Before catheterizing a patient, or even reporting that she 
is unable to void, every nursing measure should be tried to 
cause the bladder to empty itself in a normal way. 

The Procedure. —The principles to be observed in cathe¬ 
terization are: 

1. The prevention of infection by thorough cleansing of 
the part, by surrounding the part with sterile towels, using 
sterile instruments and utensils, and allowing nothing un- 
sterile to come in contact with the meatus. 

2. The avoidance of injury by using the proper catheters 
and the proper method of inserting them. 

3. The protection of the patient from exposure and 
chilling, etc. 

The articles necessary for catheterizing a female patient 
are two or three sterile catheters and sterile sponges boiled 
for five minutes (and brought to the bedside in the receptacle 
in which boiled), sterile towels for draping, sterile basin for 
receiving the urine, a basin for the discarded sponges and 
catheter, a basin of hot boric solution for cleansing the 
parts; the water in which the catheters, etc., are boiled 
may be poured off and boric acid added. 

The catheters used may be made of glass, soft rubber or 
silver. 

Glass catheters are about six inches long, with a bent, 
rounded tip and holes in the side. The advantage of glass 
is that it is easily kept clean and sterilized. The disad¬ 
vantage of glass is that it is easily broken or cracked in 
boiling and may break when in the bladder. They are used 
only for women. 


CATHETERIZATION 


A rubber catheter must always be used (i) for all restless, 
nervous, delirious or irrational patients; (2) for children and 
irresponsible patients; (3) for pregnant -women; (4) for 
conditions in which there is a stricture or obstruction in 
the urethra to the passage of the catheter; (5) following 
operations on the vagina or perineum; (6) when the vagina 
is tightly packed making the passage of the catheter difficult 
and breakage liable if glass were used. 

When a rubber catheter is used some authorities consider 
it necessary to lubricate it with a sterile lubricant, while 
others consider this unnecessary and that it is safer to use 
the catheter lubricated only by the solution in which it 
stands. 

Preparation of the Patient .—If the patient is conscious and 
rational explain the necessity for the treatment and the need 
for her cooperation. Try to relieve any nervous dread of 
exposure or discomfort. She should be thoroughly relaxed 
and remain perfectly still. One of the most essential things 
in the treatment is a good light. While very little exposure 
is necessary, the nurse should see exactly what she is doing 
and be free to give her entire attention to the treatment. 

The position of the patient is important. She should lie 
on her back near the right side of the bed, with her thighs 
and knees flexed and limbs well separated and relaxed. A 
blanket should be placed across the chest, as it is most 
important that the patient should not become chilled. After 
the patient’s gown, the upper bedclothes, the sterile draping 
and the utensils (which must be in a convenient position) are 
arranged satisfactorily and everything is in readiness to begin 
the treatment, the nurse “scrubs up,” after which she must 
touch nothing unsterile (at least with her right hand). 
Before leaving the patient to “scrub up” a sterile pad or 
folded towel may be placed over the vulva to avoid exposure. 

Method, of Procedure. —The nurse should stand on the 
patient’s right and before touching the catheter she should, 
with thumb and index finger of her l,eft hand, separate 
the labia gently but sufficiently to clearly expose the meatus. 
Then with moistened sterile sponges (in her right hand) 
she should thoroughly cleanse the parts, wiping gently but 
firmly from above downward, using each sponge only once 
and handling it so that her fingers touch nothing but the 
sterile surface of the sponge. Then, without removing the 
fingers of her left hand from the labia, with her right the 
nurse introduces the catheter directly into the urethral 
meatus without allowing it to touch anything else. The 
nurse also, though her hands are “clean,” never touches the 
end of the catheter to be inserted. 

Before inserting a glass catheter always examine it care- 


CATHETERIZATION 


fully for cracks. When inserting a glass (or silver) catheter 
introduce it with the curved tip pointing upward and direct 
it upward and backward so as to follow the curve of the 
urethra. The soft rubber catheter easily follows the curve 
of the urethra. 

Never use force when inserting the catheter, but insert 
it gently. The muscular walls of the urethra may be 
contracted, due to nervousness, which will pass away, or the 
patient may voluntarily contract the muscles if she objects 
to the treatment. Ask her to take a deep breath and to 
breathe deeply. 

When the urine stops flowing, withdraw the catheter 
slightly so that the end in the bladder will remain in the 
urine as it reaches a lower level, and wait a moment to see 
if more urine will flow. If no more comes, then withdraw 
the catheter (placing a finger over the open end), hold it 
over the basin, and, as the finger is removed, the pressure 
of the air will force the urine out. Place the catheter in the 
separate basin with the discarded sponges, etc. Before 
removing the fingers from the labia, cleanse and dry the 
parts as before. 

The patient should experience no discomfort during, and 
usually feels great relief following the treatment. 

Catheterization of a Male Patient 

Male patients are catheterized by the doctor. Pupil 
nurses are not taught to pass the catheter on a male patient 
and graduate nurses are only required to do so in most 
exceptional cases. Nurses are, however, responsible for 
preparing the articles necessary for this procedure. 

The articles required will be a sterile sheet, sterile lubri¬ 
cant for the catheters, sterile gauze wipes or sponges for 
cleansing, a basin containing boric acid solution, 2 per cent., 
a pair of sterile dressing forceps, a sterile receptacle con¬ 
taining several sterile catheters of different sizes, the most 
commonly called for being number ten, fourteen and eight¬ 
een, French soft rubber catheters. A receptacle for the 
discarded wipes and catheters will also be required. 

Rubber catheters are sterilized by boiling for three minutes. 
Too long boiling softens and roughens the catheters so that 
they become unfit for use. 

Method of Procedure. —If, in an emergency, a nurse is 
required to catheterize a male patient, she should take the 
same precautions to prevent infection and exposure as when 
catheterizing a female patient. The patient may be suitably 
draped and the treatment performed with very little exposure. 
The catheter is lubricated with a sterile lubricant. Before 
inserting the catheter the penis is cleansed; the foreskin 


CATHETERS 


is gently pushed back and the glans and meatus are cleansed 
with the boric acid solution in order to remove any secre¬ 
tions which may be present. The penis is held at an angle 
of about 60 degrees and the catheter is gently inserted. 
Frequently some resistance to the passage of the tube 
is met with, due to the contraction of muscles. When this 
occurs wait a moment and the catheter can then be gently 
inserted further. Force must never be used in passing a 
catheter as great and permanent harm may be done in this 
way. If the resistance is due to the nervous contrac¬ 
tion of the muscles it will soon pass away; if not, further 
attempts to pass the catheter will only do harm. After the 
urine is removed from the bladder the parts are cleansed 
and dried as before. 

See Urine, Retention of. 

CATHETERS, CARE OF 

Glass catheters are used for women only. After use, 
they are washed with green soap and tepid water, rinsed in 
clear water, and boiled for ten minutes. When not in use, 
they may be stored in a i to 40 carbolic acid solution. 

Soft Rubber Catheters .—After use they are cleansed with 
green soap and tepid water, irrigating from the eye down¬ 
ward. They are boiled for ten minutes to sterilize. If to be 
kept sterile when not in use they are drained and dried 
in a sterile towel and put away in a dry sterile towel. These 
catheters are then considered clean, not sterile, and are 
resterilized by boiling before use. 

Gum Elastic Catheters .—These may be cleansed in the 
same way as rubber catheters and sterilized by boiling. 
These catheters become very soft and are very easily injured 
and ruined when hot. If not properly treated they roughen, 
bend, and lose their shape so that they are unfit for use. 
Roughened catheters, whether of glass, rubber or gum elastic, 
etc., should never be used. They irritate the delicate 
mucous membrane of the urethra and predispose to infec¬ 
tion. To boil gum elastic catheters they should be rolled 
in gauze so that they do not touch each other. The vessel 
in which they are boiled must be longer than the catheters 
so that they do not become bent. The water must be boil¬ 
ing and the catheters should not remain in the water longer 
than necessary. They should be lifted from the water in 
the gauze in which they are wrapped. The catheters them¬ 
selves must not be touohed until they are cold. 

CAUSTIC POTASH 

See Alkalies. 


CERATES 


CAUSTIC SODA 

See Alkalies. 

CAUSTICS 

See Escharotics. 

CAUTERY 

See Thermo-cautery. 

CAYENNE PEPPER 

See Capsicum. 

CELLULITIS 

When an infection invades and infiltrates the surround¬ 
ing tissue the condition is called cellulitis. The organisms 
which produce cellulitis are more commonly the streptococci, 
the staphylococcus aureus or albus and the colon bacillus. 
Where the tissues are loose the infection spreads very 
rapidly. Cellulitis may result from the spreading of in¬ 
fection already present in a post-operative wound or from 
the invasion of the wound by bacteria. When not associated 
with a post-operative wound it may be due to infection 
following an injury to the tissues resulting from friction, 
heat or cold, counter-irritants, injections of irritating drugs, 
and snake or insect bites. Even a pin prick, if it introduces 
the germs, may be followed by a serious and even fatal 
cellulitis. When it occurs in patients where the circula¬ 
tion is poor, as in marked arteriosclerosis, or when the metab¬ 
olism of the tissues is interfered with and the blood is ab¬ 
normal, as in diabetes, or when the nutrition of the tissue is 
poor, as in spinal cord lesions, cellulitis may be rapidly fatal. 
Sometimes a patient’s resistance is poor to special kinds of 
infection. 

The symptoms are both local and general. The local symp¬ 
toms are those of an acute inflammatory process—heat, red¬ 
ness, swelling, intense throbbing pain, and loss of function. 
The general symptoms are due to absorption of toxins or 
septic material and are the general symptoms which accom¬ 
pany fever or sepsis. The local symptoms often resemble 
the early symptoms of erysipelas so that it is difficult to 
make a diagnosis until the demarcation in erysipelas is well 
established. Cellulitis may be mistaken for erysipelas or vice 
versa. Both spread very rapidly. 

The treatment usually consists in the application of moist 
dressings or a continuous bath, where possible, and surgical 
interference by incision and drainage. 

CERATES 

Cerates are preparations of drugs made up with white 


wax. 


CEREA FLEXIBILITAS 


CEREA FLEXIBILITAS 

Sec Suggestibility. 

CEREBROSPINAL FLUID 

Normal spinal fluid is alkaline in reaction and has a 
specific gravity of from 1.005 to 1.010. The solids con¬ 
tained in it consist of a trace of protein, 0.05 per cent., 
white blood cells, 1 to 10 per c.m., and a small amount of 
sugar. Its pressure is sufficient to support 60 to 100 mm. 
of water, or to cause the fluid to flow through the needle 
at the rate of one or two drops per second. When the 
fluid flows more slowly it may be because the needle is not 
properly inserted, or because the exudate is too thick or puru¬ 
lent, or because the intercommunication between the sub¬ 
arachnoid spaces of the brain and cord is shut off. 

In inflammation of the meninges, an examination of the 
cerebrospinal fluid may show an increase in pressure, in 
specific gravity (due to increased solids), in the amount of 
protein, and in the number of white cells or leucocytes. It 
may also show an absence of sugar, and may show the 
specific organism causing the infection. 

In meningitis, the intraspinal pressure may be very high 
(200 to 800 mm. of water), causing the fluid to flow more 
freely or even to come out in spurts. The white cell count 
may also be very high, often reaching several hundred per 
c.m. In syphilis the white cell count may be from 20 to 
200 or more. 

In tuberculous meningitis the fluid is usually clear. The 
differential leucocyte count shows an increase in lympho¬ 
cytes: There may be 100 per cent, lymphocytes. 

In acute meningitis, due to the meningococcus, the pneu¬ 
mococcus or streptococcus, the fluid may be cloudy, turbid, 
yellowish or greenish. The differential leucocyte count 
shows an increase in the polymorphonuclear white cells. 

CEREBROSPINAL MENINGITIS 

Cerebrospinal meningitis contrasts with poliomyelitis, 
while also in some clinical points resembling it. Its incuba¬ 
tion period and its prodromal period are supposed to be 
about the same respectively in length as those of poliomye¬ 
litis; the fastigium varies immensely in different cases, but 
is usually a matter of weeks. 

Poliomyelitis affects chiefly certain portions of the in¬ 
terior of the nervous system, cerebrospinal meningitis 
rather the exterior, and the coverings, of the cord and brain. 
Poliomyelitis produces typically paralysis. Cerebrospinal 
rather tends to excessive stimulation of the nerves leading 


CEREBROSPINAL MENINGITIS 


to the muscles, hence to spasms, convulsions, etc., although 
later paralysis may develop. Poliomyelitis is chiefly in 
evidence in children, cerebrospinal meningitis much more 
largely occurs in adults. Both are supposed to have ap¬ 
proximately the same incubation period, and somewhat the 
same prodromal period; but cerebrospinal meningitis, when 
recognized as such, is usually ushered in by headaches, stiff 
or retracted neck, and vomiting. The typical symptom of 
cerebrospinal meningitis is not paralysis but spasm, often 
of the eye muscles. 

Inability to straighten the knee, if the thigh be put first 
at right angles to the body (Kernig’s sign), is commonly 
present. 

A crucial distinction is obtained by lumbar puncture, the 
fluid of poliomyelitis being clear, that of cerebrospinal 
meningitis cloudy—the latter usually also containing the 
causal germ, the meningococcus, which can readily be found 
under the microscope and grown in culture. 

Cerebrospinal meningitis and poliomyelitis resemble each 
other in that the infectious period and mode of infection 
are still in doubt. Active cases in both diseases, although 
looked upon with great fear, seem seldom to produce new 
cases clearly traceable to them. The infective agent is 
supposed to be passed on from person to person until a 
susceptible one is found. 

The treatment of cerebrospinal meningitis which has 
proved most successful consists in (a) repeated lumbar 
punctures, allowing the escape of the accumulated fluid 
and thus relieving pressure, (b) the use of Flexner’s serum 
to replace the withdrawn fluid, to the extent only of one-third 
of the amount withdrawn (in order to avoid restoring the 
pressure just relieved by the withdrawal), (c) the use of 
vaccines, autogenous preferably. 

See Poliomyelitis, Acute Anterior. 

CEREBROSPINAL MENINGITIS 
Summary of Treatment 
Distribution of the Family 

The disease is contagious and isolation should be obliga¬ 
tory. 

The children of the family and other “contacts” should 
be kept from other children, as possible carriers. 

The children of the family should be isolated over a period 
that probably covers the illy defined incubation period, i.e., 
three to four weeks. 

The nasal passages of the suspects should be examined for 
diplococci. 

131 


CEREBROSPINAL MENINGITIS 


Adults, too, should be kept from the sick-room unless their 
duty keeps them there. 

Adults of the family should not come in contact with other 
children and if their duty brings them in contact with chil¬ 
dren, they should remove from the environment of the pa¬ 
tient and submit to the isolation period before seeing chil¬ 
dren again. 

“Contacts” should have their nasal secretions examined. If 
they are positive, they should keep from children during 
the epidemic and, if possible, isolate themselves until the 
cultures are negative. 

Avoid infections of nasal passages, especially during epi¬ 
demics of colds and sore throats. 

“Contacts” should use a mild spray for the throat and 
nose, 2 per cent, boric acid solution or quarter strength 
Dobell’s solution. 

Never use strong astringents. 

Nurse 

Some cases require a night and a day nurse. 

Very likely to become a “carrier.” 

Avoid contact with children. 

Remember the ease of conveyance by kissing, coughing 
and sneezing. 

Before going out clean hands and face with soap and water 
followed by alcohol or 1:1,000 bichloride and 

Spray throat and nose with the mild solutions mentioned. 

Should spray throat and nose from time to time while on 
duty. 

Room 

Choose with reference to light and air. 

Veranda or porch approach. 

Bathroom near by. 

Should be stripped of furnishings. 

Carpet lining or unbleached muslin on the floor. 

Screens for the eyes, if sensitive to the light. 

Avoid jars, noise and other sources of irritation. 

Precautions in the Sick-room 

Nasal and oral secretions should be received on rags and 
burned or disinfected in 1:20 phenol or 1:500 bichloride. 
Thermometer. 

Should be left in sick-room and kept in 2 per cent, phenol 
or in formalin. 

Eating utensils. 

Boil in sick-room, or if sent out of sick-room soak in 
phenol 1:2o for twenty minutes to half-hour, then send 
out to be boiled. 


CEREBROSPINAL MENINGITIS 


Clothes. 

Soak overnight in 1:20 or 1:50 phenol, then boil half- 
hour before before sending to the family wash or laundry. 
Urinals, bed-pans, etc. 

1 : 20 carbolic or 1 ■ 500 bichloride. 

Patient 

Isolation. 

Nightgown should be of light flannel or, if irritating, 
cotton. 

Should be open all the way down the front to facilitate 
examinations. 

Diet 

Early days do not force. 

Later consider the body needs. 

In infancy modified milk is to be further diluted. 

In stupor or dysphagia. 

Nasal or oral gavage. 

Nasal better in children; oral in infancy. 

Drinks should be forced. 

Water, alkaline waters, fruit juice, as lemonade, etc. 
Care of Body 

Skin. 

Cleansing bath of soap and water daily. 

Bed-sores. 

Prevention. Change of position. 

Scrupulous dryness; use of rings and cushions. 

Rubbing of skin with hands. 

Use of alcohol and talcum powder. 

Care of bed in avoidance of wrinkles and crumbs of food. 
When sores threaten, use air mattresses or water-beds. 
Sores should be handled on surgical principles. 

Mouth and nose. 

Remember that the secretions are infectious. 

Rinse mouth with plain water, then with 

Boric acid solution 2 per cent, to 4 per cent, or with 

Dobell’s solution quarter to half strength. 

Teeth. 

Brushed with soft brush or cotton swabs, wet with above 
solutions, care being taken to free interstices from particles 
of food. 

Remove particles between gums and cheeks. 

Sordes and coated tongue. 

Soften with half strength official peroxide of hydrogen, 
then scrape tongue with edge of whalebone. 

Follow with the boric acid or Dobell’s solution. 


CERIUM OXALATE 


Dry mouth and tongue. 

Use 2 per cent, boric acid solution, with equal amount of 
albolene. Flavor with lemon-juice. 

Nose. 

Soften hard secretions with olive oil. 

Spray with boric acid or Dobell’s solution. 

Burn all secretions as infectious. 

Nurse should carefully wash hands and use alcohol or 
i:i,ooo bichloride as an antiseptic after these ministrations. 

Eyes. 

Mild conjunctivitis is common. 

Secretions are probably infectious and should be burned. 
Cleanse eyes with 2 per cent, boric acid solution. 

Care of bowels 

Open freely at the beginning. 

Throughout the illness use, 

Milk of magnesia 2 to 4 drams, or 
Liquor magnesiae citratis 4 to 8 ounces. 

Hunyadi or similar water. 

Enemata, especially if there is vomiting, though hyperes¬ 
thesia may make it a too distressing procedure. 

Nausea 

A feature of the onset is vomiting, and it may continue 
for some time. 

One may try: 

Cracked ice. 

Mustard paste, 1 in 3, 4, 5, or 6 of flour to pit of stomach. 
Lavage. 

Bladder 

Watch for distention. 

Apply hot stupes over the epigastrium. 

Catheterize. 

Urotropin. 

Doubtful value. 

Dose: 5 grains, two to four times a day well diluted. 

CERIUM OXALATE 

It is used to check vomiting; in pregnancy, sea-sickness, 
and in other conditions. Its mode of action is unknown. 
Dose: 2 to 10 grains. 

CERUMEN, IMPACTED 

See Ear Nursing. 


See Uterus. 


CERVIX 


CHEYNE-STOKES RESPIRATIONS 


See 

Calcium. 

CHALK MIXTURE 

See 

Alcohol. 

CHAMPAGNE 

See 

Venereal 

CHANCRE 

Diseases. 

See 

Venereal 

CHANCROID 

Diseases. 

See 

Menopause. 

CHANGE OF LIFE 


CHARCOAL (CARBO LIGNI) 

Charcoal is made from wood or bones. It readily absorbs 
gases and is therefore used to remove gas from the intes¬ 
tines. 

It is best given in capsules, since it soon loses its efficiency 
when dissolved in a fluid. 

CHENOPODIUM (AMERICAN WORM SEED) 

This is the fruit of the Chenopodium ambrosioides, or 
Jerusalem oak. Its active principle is a volatile oil, which has 
an extremely unpleasant odor. It is used principally to 
destroy round worms, and should always be followed by a 
brisk cathartic. 

Preparation 

Oil of Chenopodium; dose 3 to 5 minims. 

It is usually given on sugar or in an emulsion. 

And see Anthelmintics. 

CHEST, ASPIRATION OF 

See Thoracic Aspiration. 

CHEYNE-STOKES RESPIRATIONS 

This is a type of respirations which appears in two forms: 
(1) The respirations increase in force and frequency up to 
a certain point, and then gradually decrease until they cease 
altogether, and there is a short period of apnea, then the 
respirations recommence and the cycle is repeated. (2) The 
respirations increase in force and frequency up to a certain 
point, then cease, and the period of apnea intervenes, with¬ 
out the gradual cessation of the respirations. This condi¬ 
tion is associated with disease of the kidney, brain, or heart. 
The cause is not settled, but it is of bad prognosis and 
often indicates a fatal termination. 


CHICKENPOX 


CHICKENPOX (VARICELLA) 

Chickenpox.—A communicable disease—cause unknown— 
occurring chiefly among children,, characterized by a slight 
fever, and an eruption which appears suddenly, first as small 
red spots, rapidly becoming vesicular, then pustular, about 
the size of a pea. These dry and form a crust. 

The incubation period is from two to three weeks. The 
lesions may appear on any part of the body, on both skin 
and mucous membranes. There may be few or they may 
cover the entire body. They appear in successive crops; 
the duration of each lesion is about seven days from begin¬ 
ning through crusted stage. Contagion ceases when the 
skin is free from crust. No scar is left unless the lesion has 
been infected. 

There is little to be feared from complications. The 
patient is usually mildly ill and soon recovers. 

Treatment: Isolation. Rest in bed in a well ventilated 

room. Daily warm, cleansing baths followed by anointing the 
body with some antiseptic oil or ointment - to prevent the 
lesions from becoming infected. 

Bed and body linen should be changed daily, thereby pre¬ 
venting re-infection. Finger nails should be kept short. 
The patient should have an abundance of water to drink and 
plenty of easily digested food. The remaining care is the 
same as that given to any bed patient. 

See Infectious Diseases, Course of. 

CHILBLAINS 

See Frost-bites. 

CHIMAPHILA (PIPSISSEWA) 

Chimaphila is obtained from the leaves of Chimaphila 
umbellata, an American plant. Its active principles are the 
glucosides, arbutin and chimaphilin. It also contains some 
tannic and gallic acids. 

Chimaphila produces the same effects as uva ursi. It 
contracts the mucous membranes and increases the flow of 
urine. 

Preparation 

Fluidextract of Chimaphila; dose 30 to 60 minims. 
CHINOSOL 

Chinosol or oxyquinoline sulphate is an artificial chemical 

substance which comes in the form of a yellow powder. It 
is used as an antiseptic for the skin, as a nasal spray, as a 
gargle and as a douche in 1:5,000 to 1:1,000 solutions. 


CHLORAL HYDRATE 


CHLORAL CAMPHOR 

Chloral Camphor consists of equal parts of chloral and 
camphor and is used as a local application to relieve pain. 

CHLORALFORMAMID 

Chloralformamid is a white, crystalline powder with a 
slightly bitter taste. It is a chemical compound of chloral. 

It produces sleep; its effects are similar to those of 
chloral. It does not weaken the heart action, but it is 
not as reliable as chloral. It is usually given in powder 
form, dissolved in whiskey. Dose 15 to 30 grains. 

CHLORAL HYDRATE 

Chloral is an oily, colorless liquid made by the combina¬ 
tion of chlorine gas w r ith absolute alcohol. It is not used in 
medicine, but when it is combined with water it forms 
crystals of chloral hydrate, which is the preparation ordina¬ 
rily used. 

About 5 to 15 minutes after an average dose of chloral 
hydrate is given, the patient feels tired and drowsy, and 
soon falls asleep. The sleep lasts for about five to eight 
hours. It resembles the natural sleep, and the patient can 
be easily awakened. During the sleep, the pulse and breath¬ 
ing are slow, and the pupils are contracted. When the pa¬ 
tient awakes, he may complain of a little headache and diz¬ 
ziness, and may be somewhat confused. 

Applied to the skin chloral causes redness and even 
blisters. It also acts as an antiseptic, checking the growth 
of bacteria. It occasionally causes nausea and vomiting. 
After absorption, chloral lessens the activity of the brain, 
and the reflex actions of the spinal cord; it makes the heart 
beat and the pulse slower and weaker; the breathing be¬ 
comes slower and shallower, and the body temperature is 
lowered. 

Idiosyncrasies. —Chloral often causes the following un¬ 
usual effects: 

1. Redness and swelling of the conjunctiva. 

2. Flushed face and neck. 

3. Eruptions on the skin, which often desquamate. 

4. Dyspnea. 

5. Rise of temperature. 

Dangerous Symptoms. —In giving chloral, the patient must 
be carefully watched, and the pulse should be taken very 
frequently, as sudden heart failure from chloral is not at 
all uncommon, even from a single dose. Dangerous symp¬ 
toms are: 

1. Restlessness. 

2. Slow, weak pulse. 


CHLORAL HYDRATE 


3. Slow, shallow breathing. 

4. Coma. 

The chloral should be stopped when these symptoms 
appear. The danger is usually over when the pulse is above 
60 and is regular and strong. 

Tolerance. —If chloral is taken habitually, the patient be¬ 
comes accustomed to the drug, so that large doses may be 
taken without producing any poisonous effects. 

Poisonous Effects 

Acute chloral poisoning is a condition which may result 
when an overdose of chloral is given medicinally, or from 
the malicious administration of an overdose of chloral in 
alcohol (“knockout drops”). 

Symptoms. —1. Very deep sleep from which the patient 
is aroused with difficulty. 

2. Very slow and shallow breathing. 

3. Slow, weak, irregular pulse with low blood pressure. 

4. Insensibility to pain. 

5. Contracted pupils. 

6. Relaxation of the muscles. 

7. Coma. 

8. Collapse. 

Death usually results from paralysis of the heart and 
breathing. The smallest fatal dose is 30 grains. 

Treatment.— 1. Wash out the stomach. 

2. Give artificial respiration. 

3. Keep the patient warm and quiet. Excitement may 
be fatal. 

4. Atropine, caffeine, strong coffee, or alcohol ane usually 
given to increase the action of the heart and respiration. 

Chloral Habit 

Habitual use of chloral often causes symptoms resembling 
those of chronic alcoholism: 

1. The patient feels melancholic and “blue.” 

2. Wakefulness and nervousness at night. 

3. Loss of appetite and disturbed digestion. 

4. Various eruptions on the body. 

If the drug is suddenly stopped, symptoms resembling 
delirium tremens result. To relieve these symptoms, the 
patient must be gradually weaned of the habit. 

Uses 

1. To produce sleep. 

2. To lessen the excitement of delirium tremens and 
other similar conditions. 

3. To prevent the convulsions of strychnine poisoning, 
epilepsy, uremia, etc. 


CHLORETONE 


Administration 

Chloral hydrate is best given only slightly diluted in 
syrup, about 15 minutes to a half hour before bedtime. The 
dose is 10 to 30 grains. 

CHLORALOSE 

Chloralose is a white, crystalline powder, having a bitter 
taste. It is a compound of chloral and glucose. It pro¬ 
duces sleep; its effects are similar to those of chloral, but 
it is not as reliable. Dose 5 to 10 grains. 

CHLORAMINE 

Chloramine T (Chlorazene) .—This is a sodium compound 
of a complex organic chlorine preparation. It is four times as 
strong as phenol. It acts like Dakin’s solution; it is more 
stable, lasts longer but it has not the dissolving power of 
Dakin’s solution. It is used in 1 or 2 per cent, solutions 
applied in the same manner as Dakin’s solution. It is also 
used as a mouth wash and as an irrigation for the urethra, 
bladder and uterus. 

Chloramine B. —This is a sodium preparation of a complex 
preparation (Sodium benzenesulphochloramene). It is used 
in the same manner and it has the same effects as chlora¬ 
mine T. 

See Dakin’s Solution. 

CHLORAZENE 

See Chloramine. 

CHLORCOSANE 

This is a thick liquid consisting of liquid paraffin con¬ 
taining chlorine in a stable, non-active combination. This 
substance is used merely as a solvent for dichloramine T so 
as to prevent the chlorine combining with the oil (which 
is already combined with chlorine), which would otherwise 
prevent its action. It is used as a spray. 

See Dakin’s Solution. 

CHLORETONE 

Chloretone is a white, crystalline powder which does not 
readily dissolve in water. It has an odor like camphor. 
Applied to the skin it acts as an antiseptic. When it is 
taken internally, it is rapidly absorbed into the blood, and 
acts principally on the brain, producing sleep. Chloretone 
is used to produce sleep, very frequently to check an 
epileptic attack; and to lessen other convulsions, such as 
those occurring in tetanus, etc. It is occasionally used to 
check vomiting and sea-sickness. Dose 5 to 15 grains. It 
is also used in a 1 per cent, solution. 



CHLORINE 


CHLORINE 

Chlorine is an element which occurs in the form of a 
greenish yellow gas. It is obtained from sea salt, and a 
number of its compounds are used as disinfectants. 

Antiseptic action: Chlorine gas is one of the most ef¬ 
ficient disinfectants known; especially when it is used 
in the presence of moisture. The chlorine combines with 
the hydrogen of the water, thus setting oxygen free. The 
oxygen then destroys the bacteria. A 0.3 per cent, solution 
of chlorine will destroy even the spores of bacteria in about 
three hours. Chlorine also removes obnoxious odors very 
readily (deodorant). 

Local action: Concentrated solutions of chlorine gas 

redden the skin and produce blisters if the solution is pre¬ 
vented from evaporating. On mucous membranes it in¬ 
creases the secretions. 

Internal Action: In the mouth chlorine usually causes 
profuse secretion of saliva. In the stomach and intestines 
it increases the secretions. Inhalation of chlorine gas usually 
makes the patient cough and increases the secretions of the 
bronchi. 


Poisonous Effects 

If large quantities of chlorine solutions are swallowed the 
following effects are produced: 

1. Redness and destruction of the tissues around the 
mouth. 

2. Abdominal pain. 

3. Nausea and vomiting. 

4. Collapse (cold, moist skin, rapid, thready pulse, slow 
and shallow breathing). 

If the gas is inhaled, the patient has violent coughing; 
often with bloody expectoration. 

The symptoms should be treated with alkalies, such as 
sodium bicarbonate; for the pain, morphine should be given 
as well as albumins, milk, or flour to protect the mucous 
membrane of the stomach. 


Uses 

Chlorine is used principally to disinfect stools and urine. 
It is used in the form of chlorinated lime, which liberates 
chlorine gas. It has a special advantage in removing foul 
odors. Concentrated chlorine gas, liberated by a specially 
constructed generator, is used to disinfect rooms. It is very 
efficient; but it bleaches various dyed materials. It is pre¬ 
pared by placing a dish containing equal parts of black oxide 
of manganese and salt in the center of the room. To this 
is added one tablespoonful of strong sulphuric acid diluted 

190 


CHOLERA 


one-third. Enough chlorine gas will thus be formed to 
disinfect the room. 

Preparations 

Chlorine water. —This is a solution containing 4 parts of 
chlorine gas to 1000 c.c. of water. 

It should be freshly prepared, since old preparations may 
contain hydrochloric acid. 

Chlorinated Lime or Bleaching Powder (Calx Chlorinata). 

—This is a grayish white powder containing 35 per cent, 
of chlorine gas when fresh. It is sometimes erroneously 
called chloride of lime. A fresh powder forms a clear solu¬ 
tion; otherwise the solution becomes turbid. 

Solution of Chlorinated Soda (Liquor Sodae Chlorinatae) 
(Labarracque’s or Javelle’s Solution); dose 10 to 20 
minims. 

This is a solution made from chlorinated lime and sodium 
carbonate. It contains sodium hypochlorite and sodium 
chloride. It liberates about 2)4 per cent, of chlorine gas 
and is used for cleaning medicine droppers, douche nozzles 
and other small utensils. It is especially valuable to remove 
stains. It is occasionally given internally in half a tumbler 
of warm milk. 

CHLORODYNE 

See Anesthetics (Chloroform). 

CHLOROFORM 

See Anesthetics. 

CHOLAGOGUES 

See Cathartics. 

CHOLELITHIASIS 

For this, and other words beginning with Chole—, see 
Gallstones. 

CHOLERA (ASIATIC CHOLERA) 

Cholera is an acute, specific disease characterized by pro¬ 
fuse, painless diarrhea, vomiting, rapid collapse, muscular 
cramps, and suppression of urine. 

Cause: Predisposing: Anything that will lower the re¬ 
sistance, such as bad ventilation, worry, overcrowding, under¬ 
feeding, acute infectious diseases. One of the chief causes 
is gastrointestinal disturbances. 

Exciting. The Spirillum Cholera Asiatics. The period of 
incubation is from a few hours to five days. Following 
cholera, the healthy organism may remain in the stools from 
eight to ten days, and it has been known to exist sixty 



CHOLERA 


days. The spirilla die quickly after death of the patient, 
and there is no contamination of the ground. The organism 
does not stand drying and dies in a few days on clothing 
under ordinary circumstances. There is no danger from 
dust. It resists sunlight for some time but is killed by ten 
minutes’ exposure to a temperature of 122 0 F. and by or¬ 
dinary disinfectants. 

Source of Infection Is Man.—The organisms are passed 
in enormous quantities in the stools and at times in the 
vomitus and the urine. Mild cases of cholera, and germ 
carriers are the chief sources of infection. 

Mode of Transmission: Water is one of the commonest 
modes of transmission. The organism lives a long time 
in water contaminated by the feces of cholera patients. 
Uncooked vegetables washed in such water may carry the 
infection. 

Milk may be the source by using contaminated water as 
an adulterant. 

Personal Contact is a common mode of transmission. Per¬ 
sons living together in close contact, eating and drinking 
out of the same vessel, or handling clothing and bedding 
soiled with cholera discharges. 

Flies are common carriers. 

Symptoms.—The disease sets in with mild diarrhea; there 
may be colicky pain. At first the stools consist of fecal mat¬ 
ter and are normal in color; but they soon change to profuse, 
colorless, watery liquid containing small, opaque flocculi 
resembling rice water. 

Vomiting is an early symptom. It is projectile and like 
rice water in character. The tissues become dry and shriv¬ 
eled, eyes sunken, nose pinched, cheek bones prominent, skin 
cyanotic, muscular cramps develop, and secretion of sweat 
and urine is reduced. Respiration is shallow and rapid; 
pulse very feeble. There is intense thirst. Surface tem¬ 
perature is subnormal, skin cold and clammy. Rectal tem¬ 
perature 102-104° F. The mind remains clear. The patient 
passes into coma and dies. 

Treatment: Prophylactic .—As water is the commonest 
medium by which infection is spread it is necessary to 
guard against contamination. All drinking water should be 
boiled. Avoid uncooked foods. An active campaign against 
flies should be waged. Avoid all foods which lead to gas¬ 
trointestinal disturbances. Wash the hands after going 
to toilet and before eating. All discharges of cholera pa¬ 
tients must be disinfected with equal volume of cresol solu¬ 
tion 5 per cent, and allowed to stand one hour, or a 5 
per cent, mixture of chlorinated lime may be used; or the 
feces may be mixed with sawdust and burned. All bedding 


CHOREA GRAVIDARUM 


and clothing should be soaked in a 2.5 per cent, solution of 
cresol. Final disinfection should consist of washing floors 
and walls with a 2.5 per cent, solution of cresol. Vaccina¬ 
tion gives immunity for from three to six months. 

Curative: The patient should be put to bed and isolated. 
The room should be airy and well ventilated, but the patient 
must be kept warm and during collapse external heat 
should be applied. 

Vomiting makes it impossible for the patient to take 
any nourishment or medicine by mouth. Cracked ice 
will, to some extent, control the vomiting. Rogers ad. 
vocates the use of permanganate solution on account ot 
its toxin destroying power. The patient is given all 
he can drink of calcium permanganate solution 1 to 6 
grains to the pint; or a pill of potassium permanganate 
2 grains every 15 minutes for two hours, then every 
two hours until the stools are less copious and more 
fecal in character. This occurs in from 12 to 24 hours. 
Then six to eight pills during 24 hours. To replace 
the loss of fluid from the body, normal saline solution is 
given by hyperdermoclysis. Rogers has had great success 
by using a hypertonic solution containing sodium chloride 
120 grains, potassium chloride 6 grains, calcium chloride 4 
grains to one pint of water intravenously. 

Diet: No food can be given during stage of collapse. 

When vomiting ceases, albumen water, broths, milk diluted 
with soda water, and then gruels. It is necessary to be 
careful in increasing diet, as there is danger of bringing 
on a relapse. 

See Infectious Diseases, Course of. 

CHOREA GRAVIDARUM 

When pregnancy occurs in women who are choreic, the 
movements become worse, and the condition moi e serious. 
Occasionally, however, chorea develops for the first time 
in a woman during pregnancy—chorea gravidarum. These 
cases are regarded as almost certainly toxemic in origin, 
and they are extremely serious. The movements become 
very marked, affecting both sides, and persisting through 
sleep, so that the patient grows weak and emaciated. Some 
cases end in spontaneous abortion. Late in the disease the 
temperature rises, a sign sometimes indicative of endocardi¬ 
tis. The mortality is about 20 per cent. In toxic cases 
ordinary treatment is unavailing, but rest in bed with com¬ 
plete quiet and mild discipline, combined with free elimina¬ 
tive treatment directed to the bowels, kidneys and skin, 
is successful in most cases. The results of induction of 
abortion are so variable that it should rarely be even 


CHOREA, HUNTINGTON’S 

considered. Non-toxic cases should be treated on the or¬ 
dinary lines. 

CHOREA, HUNTINGTON’S 

See Huntington’s Chorea. 

CHRYSAROBIN 

Chrysarobin is a substance obtained from cavities in the 
Andira araroba, a tree growing in India and Brazil. Its 
active principle is chrysophanic acid. 

Wien applied to the skin, it causes redness, pain and 
even swelling. Large doses, when absorbed from the skin 
or when taken internally, cause nausea, vomiting, diarrhea 
and scanty, bloody urine. 

It is used principally in 4 per cent, ointments for the 
treatment of various skin diseases. 

Araroba or Goa Powder, is the crude powder from which 
chrysarobin is made. 

CIMICIFUGA 

Cimicifuga is obtained from the roots and underground 
stems of the Cimicifuga racemosa, an American plant which 
grows abundantly in shady woods. 

It is used as a bitter, to relieve gout and rheumatism, and 
occasionally to relieve nervousness. 

Preparations 

Extract of Cimicifuga; dose 5 to 15 grains. 

Fluidextract of Cimicifuga; dose 15 to 60 minims. 

Tincture of Cimicifuga; dose 1 to 2 drams. 


See Quinine. 
See Quinine. 
See Quinine. 


CINCHONA 

CINCHONINE 

CINCHONIDINE 

CIRRHOSIS OF LIVER 


See Liver, Surgical Conditions. 


CITRIC ACID 

Citric acid is an organic acid which is found in the juice 
9f the lemon, or Citrus limonum, and the lime. Citrus 
bergamia. 

Action 

Citric acid acts like acetic acid. 

1. It increases the flow of saliva and relieves thirst. 


COCAINE 


2. It increases the appetite and the flow of gastric juice, 
thereby aiding digestion. 

3 - It slightly increases the movements of the bowels. 
Thus, the juice of half a lemon, if given before breakfast, 
is a good laxative. 

4. It increases the sweat, especially if given hot, as in a 
hot lemonade. 

5. It increases the flow of urine, in which it is excreted 
as an alkaline carbonate, thereby lessening the acidity of 
the urine. 

6. Citric acid is frequently given on shipboard as an 
article of diet, to prevent scurvy, a severe disease of the 
joints due to the lack of vegetable food in the diet. 

Citric acid is not a poisonous substance, but its continued 
use occasionally causes anemia and loss of weight. 

It is occasionally used in doses of one ounce to a pint 
of water, instead of lemonade. 

The best way to administer citric acid is in the form of 
lemonade. To produce sweating it is best given hot. 

CLARET 

See Alcohol. 

COCAINE 

Coca is obtained from the dried leaves of the Ery- 
throxylon coca, a shrub growing in South America. 

Cocaine is an alkaloid, the active principle of coca leaves. 
In the Java coca, in addition to the cocaine, another alka¬ 
loid is present: tropacocaine. 

t 

Appearance of the Patient 

A hypodermic injection of an average dose of cocaine, or 
its application to the mucous membranes, usually produces 
insensibility to pain on the area where it is injected or on 
the mucous membrane on which it is applied. As soon as 
the cocaine is absorbed, usually in ten or fifteen minutes, 
if the dose has been large, the patient becomes restless, 
somewhat more active, and more talkative. He usually feels 
happy and joyful. The patient often complains of headache, 
dryness of the throat; the pulse is rapid, strong and small, 
the breathing is rapid and deep, and the pupils are dilated. 

Local Action 

Applied to the skin, cocaine produces no effects, but ii 
it is injected under the skin, or applied to a wounded sur¬ 
face, it relieves pain. If it is injected into a nerve, it 
lessens pain in the area of skin or mucous membrane from 
which the nerve fibers come. 

On mucous membranes: Cocaine relieves pain and makes 


COCAINE 


the membrane very pale and thin, by contracting its blood 
vessels. It also checks bleeding by contracting the blood 
vessels. 

The insensibility to pain, or anesthesia, produced by 
cocaine, lasts only for a short time: for about fifteen minutes 
to a half hour, depending on the strength of the solution 
used. As soon as the cocaine is absorbed, the anesthesia 
and pallor disappear. Cocaine produces insensibility to pain 
by paralyzing the nerve endings, in the skin or mucous 
membranes, which receive impressions of pain. 

The mucous membrane of the eye, nose, pharynx, larynx, 
esophagus, stomach, urethra, bladder, vagina and rectum, 
are all affected in this way, if cocaine is applied directly 
to these mucous membranes, and it is absorbed from all of 
them. In the nose, in addition to the effects on the mucous 
membrane, it lessens the sense of smell, by paralyzing the 
nerve endings which receive impressions of smell. 

Internal Action 

In the mouth: Cocaine has a bitter taste - for a short 
time, as it soon paralyzes the ner.ve endings in the tongue 
which appreciate bitter substances. It also lessens pain on 
the mucous membrane of the mouth, and contracts its blood 
essels. 

In the stomach: Cocaine acts as a local anesthetic, and 
it contracts the blood vessels of the mucous membrane. It 
often lessens vomiting and hiccough, by paralyzing the nerve 
endings in the stomach, so that impulses which cause vomit¬ 
ing or hiccough are unable to reach the brain. 

Action on the intestines: It increases the peristalsis, 
causing more frequent movements of the bowels. 

Action after Absorption 

Cocaine is very rapidly absorbed into the blood from all 
mucous membranes, and from any region of the body where 
it may be injected; usually in about ten or fifteen minutes. 
After absorption it affects principally the circulation, the 
respiration, the brain, the pupil, the kidney, and slightly 
the muscles. 

Action on the circulation: On the heart: Cocaine makes 
the heart beat stronger and faster. 

On the blood vessels: Cocaine makes the blood vessels 
narrower, by contracting the small muscle fibers in their 
walls, and increasing the impulses for their contraction, which 
are sent out from the vasomotor center in the medulla of 
the brain. 

The total effect of cocaine on the circulation is to make 
the heart beat stronger and faster, and to increase the blood 
pressure. The pulse is therefore rapid, strong, but small. 


COCAINE 


Action on the respiration: Cocaine makes the breathing 
faster and deeper. 

Action on the brain: In large doses it increases the activ¬ 
ity of every part of the brain. The patient is wakeful, and 
more susceptible to receive impressions from his surround¬ 
ings, as a result of the increased activity of the sensory areas 
of the brain. 

The mental activities of the brain are also increased, so 
that all kinds of mental work such as reasoning, memory, 
etc., are performed better. 

The emotions, especially the pleasant ones, are more 
active and the patient is somewhat joyful and happy. 

Action on the muscles: In large doses cocaine slightly 
increases the contractions of all the muscles. 

Action on the pupils: It rapidly dilates the pupil, usually 
in about a half to one hour. It does not affect the sight for 
near and distant objects (accommodation). The effect 
wears off in about twenty-four hours. 

Action on the kidney: Cocaine increases the secretion 
of urine, as a result of its effect on the circulation and the 
blood vessels of the kidneys. 

Excretion 

Cocaine is partly excreted by the urine, but most of it is 
destroyed in the body. 

Poisonous Effects 

Cocaine poisoning occurs in two forms: acute cocaine 
poisoning, and cocaine habit, or chronic cocaine poisoning. 

Acute Cocaine Poisoning 

Acute cocaine poisoning results from overdoses of cocaine 
injected hypodermically, or from its application to the mu¬ 
cous membranes for local anesthesia. The symptoms are 
due to overactivity of the various organs of the body which 
cocaine principally affects, followed by exhaustion of these 
organs, which then produce symptoms of lessened activity 
or depression. The symptoms vary somewhat in different 
individuals. Some individuals are so susceptible to the 
drug that small doses may cause poisonous effects. 

Symptoms: i. Usually the patient becomes quite talk¬ 
ative, happy and jolly, though he may be somewhat con¬ 
fused in his speech and ideas. He is quite anxious about 
his condition. 

2. He is quite active and moves about a great deal. 

3. The pulse is very rapid and small, and the breathing 
is very rapid. 

4. The skin is pale, and covered with sweat. 

5. The pupils are widely dilated. 


COCAINE 


6. Occasionally there may be vomiting. 

7. Soon the delirium becomes more marked, the patient 
may seem to see objects about him, he may have muscular 
contractions of the hands and feet. These are soon fol¬ 
lowed by either clonic or tonic convulsions, more often 
clonic. 

8. Finally the convulsions increase, coma and collapse 
develop and death ensues. 

9. At times there may be no convulsions and no excite¬ 
ment, but sudden collapse and death. Occasionally the 
patient may be maniacal. 

Treatment: 1. Reassure the patient that his condition is 

not serious. 

2. Apply an icebag to the head. 

3. The collapse is treated with stimulants. 

Cocaine Habit 

The cocaine habit is unfortunately very common, and is 
often induced by its beneficial effects in the nose for the 
relief of hay fever, catarrh, etc., as well as from its use 
as a substitute for morphine. It is usually taken in a liquid 
or powder form. The powder is usually snuffed up into 
the nose. Many of the cocaine habitues are also addicted to 
the use of other habit-forming drugs, such as morphine, etc. 

Besides the gradual disturbance in the general health, the 
cocaine habitue develops symptoms: 

1. When not under the influence of the drug. 

2. After he has received his usual dose. 

Wien not under the effects of the drug, the individual 
feels depressed and is usually nervous, irritable and has 
twitching of the hands and arms. He is restless and cannot 
concentrate his mind on anything, and is unable to do his 
work. 

When he has received his usual dose, the habitue usually 

brightens up, feels stronger and more energetic and his 
former symptoms disappear. 

After continued use, however, he passes into a weakened 
condition of both body and mind. He becomes thin, ema¬ 
ciated and anemic. He suffers from various digestive 
disturbances, a loss of appetite, a foul breath, a drooling of 
saliva from the mouth, and constipation. He is usually 
unable to sleep. Frequently, habitues develop ascites. 

Finally, however, his mental and moral faculties become 
undermined and he eventually becomes a burden to himself, 
his family and friends, and an economic loss to society. He 
has no will power, no self-control, and does not want to 
work. He is careless of his person and of his actions. He 
forgets his responsibilities, neglects his family and develops 


COCAINE 


all sorts of base moral tendencies. He usually has various 
nervous symptoms, such as twitching of the muscles and 
peculiar sensations on the skin. Many votaries frequently 
develop hallucinations and a peculiar jumping delirium, and 
others become insane. 

The condition is best treated in special sanitariums; and 
the method consists of gradually withdrawing the drug. 

Uses 

Cocaine is the best drug for local anesthesia. It is readily 
absorbed into the blood, however, and may then cause poi- 
sonous symptoms. To avoid these symptoms, it should be 
remembered that the total amount of any solution of cocaine 
to be injected should not contain more than half a grain 
of cocaine hydrochloride, which is its maximum dose. 

As a local anesthetic, cocaine is given in the following 
ways: 

1. On mucous membranes, such as the nose, throat or 
larynx, it is applied with a cotton applicator. A io or 20 per 
cent, solution is used for this purpose. 

Occasionally a few drops of a solution of cocaine crystals 
dissolved in epinephrin or adrenalin, are used. Such a 
solution contracts the blood vessels very markedly, pre¬ 
vents the absorption of the cocaine and at the same time 
produces a maximum anesthetic effect. 

2. Infiltration anesthesia. This is a method of injecting 
cocaine in very weak solutions, such as a 1:1000 to 1:200 
solution. For large areas, large quantities of weaker solu¬ 
tions may be used. For small areas, stronger solutions, such 
as 4 per cent., may be used. To avoid poisonous effects, the 
cocaine is often injected together with epinephrin or adrenalin 
solutions. There are a number of preparations made up in 
this way. The following are the most common preparations 
of this kind: 

Braun’s Solution 

This consists of 

Cocaine hydrochloride 
Sodium chloride 
Adrenalin chloride solution 


0.5 to 0.1 
10.o to 100.0 
0.3 to 0.6 


Schleich’s Solution 


This is made by dissolving 3 tablets, 
tains 

Cocaine hydrochloride 
Morphine hydrochloride 
Sodium chloride 

in 100 c.c. of water. 


each of which con 

0.03 gm. 

0.008 gm. 

0.06 gm. 


CODEINE 


The absorption of cocaine is often prevented by tying a 
tight bandage around the part to be anesthetized, so as to 
contract its blood vessels. 

3. Cocaine is also occasionally injected into the nerve 
leading from the part to be operated upon. This lessens 
the sensibility of the area from which the nerve fibers come. 

Cocaine is also used to relieve colds in the nose (acute 
coryza), and to check vomiting and hiccough. 

Preparations 

Fluidextract of Coca; dose 30 to 60 minims. 

Wine of Coca; dose 1 to 4 drams. 

Cocaine; dose l/§ to % grain. 

This is seldom used because it does not dissolve readily 
in water. It does dissolve in oils. 

Cocaine Hydrochloride; dose % to V2 grain. 

For local applications, watery solutions are used in 
strengths varying from per cent, to 10 per cent. For 
nose and throat work 20 per cent solutions are often used, 
or even the powdered cocaine dissolved in adrenalin solu¬ 
tion may be used. 


CODEINE 

Codeine, one of the active alkaloids of opium, is a com¬ 
pound of morphine (methylmorphine). Its effects are simi¬ 
lar to those of morphine, with the following differences: 

1. It does not produce sleep as readily as morphine, and 
the sleep is very light. 

2. It does not slow the breathing as much as morphine, 
and is therefore safer. 

3. It does not produce constipation. 

4. It is not so apt to induce the habit. 

See Morphine and Opium. 

Preparations 

Codeine; dose % to 1 grain. 

Codeine Sulphate; dose 14 to 1 grain. 

Codeine Phosphate; dose 14 to 1 grain. 

COD LIVER OIL (OLEUM MORRHUJE) 

Cod liver oil is obtained from the livers of various species 
of codfish, especially the Gadus morrhua. 

It consists of the various fats: olein, stearin, and palmitin, 
and some fatty acids. It also contains very small quantities 
of iodine, chlorine, bromine, phosphorus, and other sub¬ 
stances. 

Action 

Cod liver oil improves the general condition of the patient 
if given for some time. It increases the appetite, and it 


COLCHICUM 

makes the patient stronger, stouter and healthier. Its 
effect depends largely upon the fats which it contains. These 
differ, however, from ordinary fats taken in the food, in 
being more easily digested, absorbed, and assimilated by 
the body. Cod liver oil is digested in the intestines, and is 
then deposited as fat in the various tissues and organs of 
the body, thereby building up the patient. 

In overdoses, it causes nausea; occasionally, vomiting and 
diarrhea. 

Uses 

Cod liver oil is given principally in “run down” condi¬ 
tions, and in chronic wasting diseases, such as tuberculosis. 
It is often given together with malt or creosote. 

It is usually given only in winter; patients dislike it during 
the summer months. 

Administration 

The unpleasant taste and odor of cod liver oil can be dis¬ 
guised in the following ways: 

1. By giving the oil in brandy, wine, or lemon juice, in the 
same way as castor oil (see Castor Oil). 

2. By taking a little peppermint, and then putting the 
cod liver oil in the mouth without allowing the lips to touch 
it, so that the smell does not reach the nose. 

All preparations of cod liver oil should be given about 
three quarters of an hour to an hour after meals, the time 
when most digestion takes place. 

In children, when it cannot be given by the mouth, cod 
liver oil may be rubbed on the skin of the chest or abdomen, 
before retiring, as it is readily absorbed from the skin. 

Preparations 

Cod Liver Oil (Oleum Morrhuse) ; dose i to 4 drams. 

Emulsion of Cod Liver Oil; dose 1 to 2 drams. 

This contains 50 per cent, of cod liver oil. 

Emulsion of Cod Liver Oil with Hypophosphites; dose 

1 to 2 drams. 

COFFEE 

See Caffeine. 

COFFEE HABIT 

See Caffeine. 

COGNAC 

See Alcohol. 

COLCHICINE 

See Colchicum. 

COLCHICUM (MEADOW SAFFRON) 

Colchicum is obtained from the seed, Colchici semen, and 
underground stem, Colchici cormus, of the meadow saffron 


COLCHICUM 


or Colchicum autumnale, a small plant growing in Europe. 
The active principle is an alkaloid colchicine. 

Appearance of the Patient 

An ordinary dose of colchicum causes very little effect, 
but several hours after a moderate dose is given, the patient 
complains of some abdominal pain, perhaps of a little nausea, 
and later he has frequent movements of the bowels and the 
urine may be somewhat increased. The pulse may be a 
little slower and occasionally the tears, saliva and sweat are 
somewhat increased. 

If the patient is suffering from an attack of acute gout, 
the severe pains of this condition are usually relieved. 

Local action: Applied to the skin or mucous mem¬ 
branes, it acts as an irritant. 

When given internally it irritates the mucous membrane 
of the stomach, causing nausea and vomiting. 

It is slowly absorbed from the stomach. After absorption 
it principally affects acute gout. It also increases the secre¬ 
tion of urine. Large doses make the pulse and breathing 
somewhat slower. 

Poisonous Effects 

Colchicum is very violent poison, small doses having 
caused death. An overdose of colchicum usually causes the 
following symptoms within a few hours: 

1. Severe abdominal pain. 

2. Nausea, and continual profuse vomiting, which is ac¬ 
companied by profuse secretion of saliva, tears and mucus 
from the nose. 

3. Profuse diarrhea, often with bloody stools. 

4. Scanty and bloody urine, or there may be no urine 
secreted at all. Occasionally the urine may be increased. 

5. Spasms of the muscles, even convulsions, followed by 
great muscular weakness, with slow movements and paraly¬ 
sis. 

6. Collapse (rapid, thready pulse, slow and shallow breath¬ 
ing, cold moist skin). 

Death soon results from respiratory paralysis. 

Treatment 

1. Give tannic acid preparations, to neutralize the col¬ 
chicum. 

2. Wash out the stomach. 

3. Protect the mucous membrane by white of egg, milk, 
etc. 

4. Keep the patient quiet. 

5. The collapse is treated with stimulants, such as caf¬ 
feine, strychnine, etc. 


COLD 


Preparations 

Extract of Colchicum Stems; dose 1/2 to 2 grains. 

Wine of Colchicum Seeds; dose 10 to 60 minims. 

This contains 10 per cent, of colchicum and is the prepa¬ 
ration commonly used. 

Fluidextract of Colchicum Seeds; dose 2 to 5 minims. 

Tincture of Colchicum Seeds; dose 5 to 15 minims. 

Colchicine, (the active principle); dose 1/120 of a grain. 

COLD, APPLICATION AND EFFECTS OF 

Action of Cold:— 

1. On the Skin, Mucous Membrane and Adjoining Tissues. 
— Cold contracts the involuntary muscles in the skin and 
this gives it the appearance of gooseflesh. The resulting 
pressure squeezes the blood out of the capillaries. Cold 
also causes the contraction of the blood vessels in the 
skin. An inflammatory process, if present, will be checked. 

2. On Nutrition. —Cold is a vital depressant. It checks 
the activities of all living things. 

3. On Bacteria. —Cold checks the growth and activities of 
bacteria as they, like the body cells, are made of protoplasm. 
In this way cold checks inflammation and the process of 
suppuration, if present. 

Action of Cold, if Prolonged:— 

1. On the Nerves. —Prolonged applications deaden nerve 
endings and in this way will destroy all sensation. 

2. On the Blood Supply. —By lessening the blood supply 
to the part, they interfere with its supply of food and 
oxygen. 

3. On Nutrition and Function. —Cold, if too prolonged, 
lowers the temperature and lessens the activities of the 
cells to such a degree that the function of the part may be 
completely lost. It may even cause death of the part. 

Symptoms and Signs to be Avoided in Making Cold 
Application. —A blue, purplish, mottled appearance of the 
skin, with numbness or stiffness of the part, indicates that 
the tissues are in danger of injury, death and sloughing. 
Should these symptoms appear, the application should be 
removed and the condition reported to the doctor. When 
these signs are present circulation in the part should be 
stimulated, not checked. 

Conditions and Purposes for which an Ice-Bag or Cold 
Compresses are Commonly Used:— 

1. To check inflammation and congestion; to prevent or 
reduce swelling; to relieve pain; to check bleeding and dis¬ 
coloration in such conditions as the following: A bruise, 
wound, burn, sprain, fracture, acutely inflamed joint, hem¬ 
orrhoids, phlebitis, tonsillitis and diphtheria, etc. 


COLD IN THE HEAD 


2. To check inflammation and prevent suppuration or abs¬ 
cess formation in an infected finger or wound, a stye, boil, 
or abscess in a tooth or ear. 

And see Ice-bag. 


COLD IN THE HEAD 

See Coryza and Cough and Colds. 

COLIC, IN CHILDREN 

Colic is usually a result of gas or air in the stomach or 
intestines, or it may be indirectly due to constipation or 
unsuitable food, or to cold. 

Symptoms. —As the gas presses on sensitive parts and 
on nerves, the pain is very sharp and severe and the child 
instinctively draws up the legs towards the body, as this 
position relaxes the muscles of the abdomen which are 
tense and hard. The child’s cries are hard and strong 
and are repeated at intervals until relieved. 

Treatment. —If the gas is in the stomach, put the child 
over your shoulder and pat the back. Give' warm water 
with a little bicarbonate of soda or peppermint in it. Lay 
the child, face downward, with the abdomen over a hot 
water bag for heat and pressure, which relieves the pain, 
or put the feet in hot water and mustard, lubricating the 
feet first to prevent the skin being irritated. If the colic 
is severe, an entire hot bath can be given, which relaxes the 
muscles, allowing the gas to pass off more easily. An 
enema of soap suds with ten drops of turpentine added to 
it will usually give the quickest relief, or even inserting 
the rectal tube and leaving it in the rectum aids in ex¬ 
pelling the gas. Rubbing the abdomen also provides re¬ 
lief. 


COLLAPSE 

The symptoms and treatment of collapse are the same as 
in shock. The conditions are identical but the term collapse 
is usually used when the prostration is the result of disease 
whereas the term shock is used when it is the result of a 
surgical condition such as an accident or operation. 

See Shock. 


COLLARGOL 

Collargol (colloidal silver Crede) is a solution of very 
finely divided silver, in albumen, containing about 85 per 
cent, of silver. It is used as an antiseptic both locally, and 
injected into the blood. 

It is often given by direct injection into the veins, in 
cases of sepsis, in y 2 per cent, solutions. It is also used in 


COLON IRRIGATION 


the form of bougies, vaginal suppositories and dusting pow¬ 
ders. 

Collargol Ointment. —This contains 15 per cent, of collar- 
gol. It is used principally in acute mastitis, or inflammation of 
the breast. About 30 to 60 grains are rubbed thoroughly on 
the skin. 

The dose of collargol is 1 grain. 

COLLES’ LAW 

A man with tertiary syphilis may procreate a syphilitic 
child without apparently infecting the mother. In such cases 
the mother can nurse the child without acquiring the disease, 
whereas a wet nurse cannot do so. This is known as Codes’ 
Law. The explanation is either that the mother has had a 
very mild attack without any external manifestations, and so 
acquired immunity; or that an immunity has been transmitted 
from the fetus to the mother. 

COLLODIUM (Collodion) 

This is a 4 per cent, solution of pyroxilin or soluble gun 
cotton, in alcohol and ether. When collodion is applied to 
the skin, the alcohol and ether evaporate, leaving a colorless, 
transparent contractile film, which is strongly adherent to 
the skin and protects it. 

Flexible Collodion contains Canada turpentine and castor 
oil in addition to the other ingredients, and is more pliable. 

Styptic Collodion contains 20 per cent, of tannic acid 
and is therefore astringent. (See Tannic Acid.) 

COLOCYNTH 

Colocynth is the pulp of the bitter cucumber or CitrulJus 
colocynthis ; its active principle is colocynthin, a resinous 
substance. 

Preparations 

Extract of'Colocynth; dose 2 to 5 grains. 

Compound Extract of Colocynth; dose 3 to 15 grains. 

Containing colocynth, aloes, scammony and cardamom'. 

Colocynthin (active principle); dose 1/12 to 1/6 of a 
grain. 

See Cathartics. 

COLON IRRIGATION, OR ENTEROCLYSIS 

Conditions and Purposes for which Colon Irrigations are 
d ven ,—!, After operations for the following purposes: 

(a) To thoroughly cleanse the large intestines of excess 
mucus, feces, toxic and putrefying matter. Colon irrigations 
are particularly valuable after operations on the alimentary 
tract or on the gall ducts. 


COLON IRRIGATION 




(b) To stimulate peristalsis and relieve flatulence. 

(c) To supply heat as a stimulant in shock or collapse. 

(d) To supply fluid to the body in order to increase the 
volume of blood, raise the blood-pressure and stimulate the 
heart; to relieve thirst; to supply fluid lost by vomiting, 
diarrhea, or hemorrhage; to dilute toxins in the body; to 
stimulate and flush the kidneys and relieve suppression 

2. In constipation. 

3. In obstruction; the pressure must be low; the solution 
must be given slowly, the flow being constant, not jerky. 

4. In dysentery, to cleanse from mucus and pus, and to 
dilute the toxins. 

5. In inflammatory diseases of the lining of the large intes¬ 
tines, to supply local remedies such as tannic acid, boric 
acid, etc. 

6. In inflammation of the kidneys and pelvic viscera. 

7. In colic—hepatic, biliary, renal, or intestinal—to relax 
the muscles and relieve pain. 

8. In toxemia and uremic poisoning, to dilute and help 
eliminate the poisons. 

9. In poisoning from bichloride of mercury, etc., in order 
to dilute and remove the poison from the intestines and 
body, to stimulate and flush the kidneys, and to prevent its 
destructive effect upon them and the resulting danger of 
acute nephritis and suppression, which might prove fatal. 

The Important Factors to Consider in Giving the Treat¬ 
ment in order to Get the best Results. —1. The articles re¬ 
quired for the treatment will depend somewhat upon the 
method. 

(a) For the patient and bed. —A blanket will be necessary 
to cover the patient; a towel and Kelly pad will be required 
to protect the bed and direct the return flow of the solution 
into the receptacle on the floor. 

(b) For the treatment will be required an irrigating pole, 
irrigating can with tubing, clamp and connecting tip attached, 
a covered basin with two rectal tubes of suitable size, one 
larger than the other, vaselin for lubrication, a pail for the 
return, a large pitcher (2 gallon) with the solution and a 
basin of soap and water, sponges and towel for cleansing 
and drying the patient. 

2. The solution used depends upon the purpose. It may be: 

(a) Normal saline is usually used for cleansing. Medica¬ 
tions may be added to the solution, if desired. 

(b) Plain water is used when the treatment is given to 
relieve thirst or to stimulate the kidneys or to supply fluid 
for any reason. 

(c) Potassium acetate (one dram to a pint) is frequently 
added for its diuretic effect. 




COLON IRRIGATION 


3. The temperature of the solution is usually from 116 to 
120° F. 

4. The amount of solution used is usually from two to 

three gallons. When given for cleansing purposes the 
amount is determined by the result, as the treatment is 

continued until the return is clear. 

5. The rectal tubes used and the way in which they are 

inserted also depend upon the purpose. When used for 
cleansing - purposes, the inlet tube should be smaller than 

the outlet tube (a catheter may be used) in order to allow 
for the return not only of the fluid but of the feces, flatus, 
and mucus, etc. The inlet tube should be inserted about 
6 inches while the outlet tube is inserted about 3 or zVi 
inches. Each tube should be marked with a narrow strip of 
adhesive plaster indicating when the tube has been inserted 
the desired distance and whether meant for the inlet or 

outlet of fluid. When inserted the adhesive marks on the 
tubes are opposite and just without the anus. If the injec¬ 
tion is given to supply fluid, in order to have some of the fluid 
retained, the tubes should be about the same, or the outlet 
tube should be a little smaller than the inlet tube. For the 
comfort of the patient medium sized tubes only should be 
used. 

Position of the Patient. —Some prefer to give the treat¬ 
ment with the patient drawn to the side of the bed, in the 
left Sims’ position, that is, on her ’left side with the knees 
flexed, the right slightly more than the left. In this position 
the fluid is carried by gravity into the sigmoid and descending 
colon and by antiperistalsis may be carried to the ileo-cecal 
valve. 

Others prefer the right Sims’ position. When in this posi¬ 
tion, the solution is carried by gravity along the sigmoid and 
descending colon, and down the transverse colon to gradually 
collect in the ascending colon and cecum. Care should be 
taken not to use more water than is necessary and not to 
overdistend the bowel. 

In obstinate intestinal obstruction, when irrigations with 
the patient in the above positions fail to bring about evacua¬ 
tions or relieve the condition, sometimes the knee-chest 
position is used. The advantages of this position, in irrigat¬ 
ing the colon, are that it allows the solution to run in easily 
by gravity so that it reaches all parts of the colon and removes 
threadworms, excess mucus or accumulated feces from the 
cecum and entire colon. The disadvantages are that it is 
very trying and apt to be exhausting, particularly to a 
patient already weakened by disease. In all cases the 
patient must be carefully supported by an assistant and the 
treatment given as gently and skilfully as possible. 


COMPOUND CATHARTIC PILLS 


Method of Procedure. —Hang the irrigating can about 3 
feet above the bed; attach the tubing, clamp and inlet tube; 
pour the solution into the can; allow the solution to run 
through the tubing to expel the air and warm the tubing; 
then clamp it. Lubricate both the tubes and insert them 
both at the same time. This is easier and causes much 
less distress to the patient; when one is inserted the sphincter 
of the anus closes tightly on it, making it very difficult to 
insert the second tube. Sometimes the insertion of the two 
tubes together is made more easily if a hole is made in the 
side of the outflow tube into which the end of the inflow tube 
is inserted. They are thus inserted as one tube. After they 
are inserted to the mark on the inflow tube, both tubes are 
then adjusted so that each is inserted the desired distance 
as indicated by the markers on the tubes. The end of 
the outflow tube should be about a foot below the level of 
the patient in order to avoid too great suction. This woufd 
be apt to draw the mucous membrane into the holes in the 
outlet tube, and not only interfere with the return, but also 
injure the delicate membrane. If the outflow colon tube is 
not long enough to permit this it should be attached by a 
connecting tip to another piece of tubing. Also if this 
tubing does not extend to within about a foot of the pail 
on the floor, when considerable gas is expelled it will scatter 
the fluid and fecal matter, soiling the bed, etc. When 
the distance from the pail is too great, the noise and splash¬ 
ing are also objectionable. Inject the solution slowly so 
as not to excite the bowel to contraction. This allows the 
desired amount to be given and secures the desired effect— 
thorough cleansing or retention, etc. Very little force should 
be used. 

If the patient complains of abdominal pain, clamp the 
inlet tube for a few seconds and note whether flatus is 
expelled or not—pain is frequently due to the contraction 
of the muscles in the effort to expel the gas. If the pain is 
continuous, stop the treatment. If properly given there 
is usually no pain. If there is difficulty in obtaining the 
return, move the outlet tube up or down. It may be neces¬ 
sary to remove and cleanse it. Stop tJie treatment if the 
patient shows signs of exhaustion. 

When the desired effect has been attained remove the 
tubes gently; cleanse the patient; remove the Kelly pad and 
dry the parts. If the parts are irritated a soothing ointment 
should be applied. 


COMPOUND CATHARTIC PILLS 

See Cathartic Pills. 


CONIUM 


COMPOUND SPIRITS OF ETHER (HOFFMAN’S 
ANODYNE) 

Compound spirits of ether, or Hoffman’s anodyne, is used 
principally to lessen nervousness and calm the patient. It 
also checks the formation of gas in the stomach. Its effect 
is due principally to the ethereal oil which it contains. 
Dose 30 to 60 minims. 

COMPRESSION OF BRAIN 

See Brain. 

CONFECTIONS 

Confections are preparations of drugs made up to dis¬ 
guise the taste of unpleasant tasting substances. They 
are usually made up with honey and sugar. 

CONFINEMENT, DATE OF 

Estimation of the Probable Date of Confinement. —In 

women who have been menstruating normally the nearest 
approach to an accurate estimate is obtained by calculating 
from the last menstrual period. It is assumed that the 
fertile coitus occurred just after the last period. Therefore 
calculating from the first day of the last period, which is 
generally the date remembered by the patient, allowance of 
four days is made for menstruation, and another three days 
before fertilization occurs, making in all seven days from 
the start of the last period. Adding these seven to the 
273 of normal gestation, we conclude that labor is likely to 
ensue 280 days from the beginning of the last menstruation. 
The actual date is estimated roughly by adding the seven 
days and counting forwards nine calendar months, or back¬ 
wards three months. 

For example, supposing a woman began her last menstrual 
period on the 3rd of September, add to that 7 days, bringing 
us to the 10th, and count forwards nine months or backwards 
three. The date of probable confinement is the 10th of June. 

It must always be remembered that this date is merely 
an approximate one, and many cases will be found to termi¬ 
nate a few days earlier, or as much as three weeks later. The 
explanation of the latter is that the fertile coitus occurred 
not just after the last period, as was assumed, but just 
before the first period missed. 

See Labor, and Table on Next Page. 

CONIUM (SPOTTED HEMLOCK) 

Conium is obtained from the fruit and flowers of the 
Conium maculatum, or poison hemlock, a European plant. 
Its active principle is coniine, a liquid alkaloid. 


CONSTIPATION 


Applied locally, conium causes intense redness and swell¬ 
ing. 

When taken internally, it acts like gelsemium, causing 
muscular weakness by paralyzing the nerve of the muscles. 

In large doses it makes the breathing slower. 

Poisonous Effects 

Symptoms. —i. The lower extremities become weak and 
heavy. The patient lies down because of the weakness. If 
he attempts to walk, he staggers and falls. The eyes may 
be turned in, the lids may droop, and the pupils are dilated. 
The patient complains of headache and he can hardly lift 
his head. 

2. The pulse is slow at first, but soon becomes rapid and 
weak. 

3. The skin is moist and cold. 

4. The breathing becomes slow and shallow, and the 
patient dies in a short time from arrest of breathing. 

Uses 

Conium is very rarely used at present, possibly once in a 
great while to lessen the spasms of whooping cough. It is 
a very dangerous drug. 

Preparation 

Pluidextract of Conium; dose 2 to 8 minims. 

CONSTIPATION 

Constipation is at all times a serious menace, to a healthy 
condition of the body. When this exists the residue or 
waste of one part of the body is not expelled in the normal 
way by the muscular action of the colon but is retained in 
the system longer than usual and from this there is an 
absorption back into the tissues with the result that the 
patient has the symptoms resembling those of an enervating, 
slow poison, with consequent lack of energy, heaviness and 
irritability, besides the distress of an accumulation of gas 
in the abdomen. 

In time of illness there is a natural tendency to consti¬ 
pation due to the lack of general exercise and the consequent 
inactivity of the muscles of the intestines; and also because 
the diet at such times consists of more condensed food, 
most of which is absorbed without leaving sufficient waste 
to stimulate the muscles of the colon and keep them active. 

Treatment. The influence of tie habit of evacuating 
the bowels at a regular hour each day has the most per¬ 
manent effect in overcoming constipation, and even in time 
of illness this has proved an efficient help towards counteract¬ 
ing this tendency. 


ELY’S TABLE FOR DATE OF CONFINEMENT 


CONFINEMENT 


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CONSTIPATION 


Exercise the muscles of the legs which directly affect 
the intestinal muscles. The simplest way of doing this is 
to walk (even walking up and down stairs). If exercise can 
be combined with pleasure, so much the better. 

Rub the muscles of the colon in the natural direction 
up the right side, across the top and down the left side. 

Allow the patient to drink freely of water because fluids, 
being absorbed in the large intestines, stimulate the muscles 
there. Also give fruit and green vegetables for the sake 
of the mineral salts contained in them, which have the same 
effect. The fiber of the vegetables, well cooked and 
unstrained, as well as coarse grained cereals and breads 
are valuable in the diet as all of these leave more bulk 
or waste which is not absorbed, and their presence in the 
colon stimulates the muscles to act and expel the feces from 
the rectum. 

An enema or laxative is frequently given to overcome this 
condition when other efforts fail, 

CONSTIPATION, POST-OPERATIVE 

Most people after operation are very constipated. Con¬ 
stipation has very serious sequelae and the importance of 
impressing upon the patient’s mind the necessity of a daily 
movement of the bowels cannot be over-emphasized. There 
should be a regular time for moving the bowels, which 
should be observed conscientiously. The best time is shortly 
after breakfast; the patient should remain seated on the 
toilet for at least five or ten minutes, and then if there is 
no desire to move the bowels, a glycerin suppository should 
be inserted to stimulate the movement. Provided there is 
no contraindication to any of the coarser vegetables, the 
patient should be placed upon the anti-constipation diet. 
Diet for Anti-Constipation. 

Breakfast 

Any fruit, fresh, cooked, preserved, or dried. 

Shredded wheat, Thomas uncooked wheat biscuit, or oat¬ 
meal, or toasted corn flakes with cream if possible, 
otherwise a small amount of milk and sugar or molasses. 

Bread.—Use only graham, rye, bran, whole wheat or corn 
bread. 

Butter, jam, jelly, or honey. Coffee with cream and sugar. 

Luncheon and Dinner 

Soup.—Any kind except those thickened with flour, or 
containing milk. 

Fish.—Meat, or eggs in moderation. Eat as much of the 
fat as possible. 

Vegetables.—Fresh or canned in any quantities. Green 
salads with olive oil. 


CONTAGIOUS DISEASES 

Desserts.—Fresh fruit or fruit cooked or preserved is 
best; also jellies prepared with coffee, wine and lemon, 
etc. Water ices may be eaten freely but only small 
amounts of ice cream may be taken. The undercrusts 
of pies may not be eaten. 

General Directions. —Take at least a glass of water before 
breakfast, one in the middle of the day, and one at night. 
In addition take as much water as may be desired. This 
may be plain water, vichy or any carbonated water. Butter¬ 
milk, sour milk, cider, beer, and white wine are allowed. 
Butter in any quantity is permitted. 

Avoid tea, red wine, milk and whiskey, white bread, 
noodles, vermicelli, macaroni, cake, rice, barley, potatoes, and 
cheese. 

General Rules. —Have a regular time for going to the 
toilet. Take a daily walk in the open air. Practise the 
setting-up exercises daily. 

Setting-up Exercises.— 

1. Knees stiff; bend forward and try to touch floor with 
fingers. 

2. Bend body backward from hips. 

3. Bend body to the right and left from hips. 

4. Rotate to the right and to the left on hips. 

CONTAGIOUS DISEASES, NURSING CARE Or 

In caring for patients ill with a contagious disease, remem¬ 
ber that contagion is spread either by direct or indirect 
contact. Direct contact —with patient or discharges. Indirect 
contact —Utensils or articles which have beerl infected by 
the patient who has a contagious disease. 

These patients should be isolated, and the isolation room 
equipped with all articles and utensils necessary for the 
care of the patient, and the cleanliness of the room. 

When the patient is discharged, all articles must be 
disinfected. Fountain pens, a watch or anything with a 
hard surface, may be wiped off carefully, with carbolic solu¬ 
tion. Books cannot be disinfected. They should be burned 
if the patient has been in contact with them while he is 
in an infectious stage. 

A gown should be worn by the attendant, even though 
the contact with the patient may be slight. A nurse carrying 
utensils or waste material from the isolated room must wear 
a gown until the articles are deposited. 

When a gown is removed, wash hands before removing. 
Hang the gown, folding the insides together, that the 
infected portion may not touch the clean surface. Wash 
the hands again. 

Nurses must wash their hands before giving diets, after 


CONTAGIOUS DISEASES 


giving treatment, after touching the patient or any utensil 
which may be infected, and after leaving the room. 

Every nurse should be sure that visitors do not carry 
contagion. Visitors’ clothing, while in the room, should 
be entirely covered by a gown. After removal of gown, 

hands should be carefully washed before putting on wraps. 

Patient’s tray may be prepared in the kitchen. Before 
carrying the tray to the patient, place a large pan of water 

on the stove to boil; on returning to the kitchen, the nurse, 

wearing a gown, must burn all refuse, and place the tray 
and dishes in the pan of boiling water, which must entirely 
cover the articles to be sterilized. They should boil for 
twenty minutes. 

Infected clothing may be wrapped in a clean sheet and 
placed in boiling water for twenty minutes. 

A patient ready to be discharged may be taken to the 
bathroom, and standing upon a clean sheet, disrobed, 
placing infected clothes upon the sheet which is wrapped 

around them, later to be placed within boiler as directed 
above. 

The patient is bathed, hair shampooed, and when dressed 
in clean clothing may be released. The tub must be disin¬ 
fected. 

All washable articles should be boiled, and all furniture 
which may have been infected by the patient, disinfected. 
All discharges and waste materials must be disinfected or 
cremated. 

If a patient dies, the body is prepared in usual manner, 
and wrapped in a sheet which is saturated with a i : 500 
solution of bichloride of mercury. 

General Care of Patient. 

A daily bath is necessary, especially in the exanthemata. 

The mouth should be kept clean, and if the lips are dry, 
anoint them with boric ointment, unless otherwise ordered. 
Collection of dried mucus is to be removed from the nose 
as often as necessary; care must be taken not to cause 
abrasions, for thus a larger field is made upon which the 
organisms may grow. Mucus may be softened by carrying 
boric ointment well up into the nose, never using force, 
and when the discharge is softened, it may be removed 
with a swab, dipped in warm boric acid solution. 

Unless otherwise ordered, nurses must give fluids fre¬ 
quently. Watch all discharges, and report any abnormality. 

Measure and note the quantity and the color of the 
urine. Report any change in character. 

Report vomiting immediately. In an apparently convales¬ 
cent patient, there is no more alarming symptom. 






CONTUSIONS 


Watch for and report edema, and if this symptom occurs, 
keep the patient quiet and warm until the doctor arrives. 

Always watch the pulse carefully. 

Liquid diet is to be given until other orders are received 
from the physician. 

Fresh air and warm covering, sufficient to render the skin 
warm to the touch. 

Bowels to be kept open. Have an order from the attend¬ 
ing physician for type of cathartic most suitable for the 
disease. 


Nurses’ Care of Herself 

If a patient coughs in face, wash immediately. 

If discharges are coughed into the eyes, irrigate thoroughly 
with warm boric solution, followed by argyrol. Delay may 
cause loss of sight. 

Wash hands before using handkerchief, before eating, 
before and after giving treatments, and when leaving 
patients. 

If there is an abrasion on the skin, or around the nails, 
keep it covered, so that it will not become infected. 

Never eat or drink infected food or use infected dishes. 

Rest when possible, and have some recreation away 
from the patient, taking all precautions that no contagion 
is carried from the patient to other people. 

There is no reason why nurses who care for contagious 
diseases should not mingle with other people if they are 
conscientious in carrying out their technique.. 

When leaving the patient, the same care must be taken in 
disinfecting that was given the patient. 

CONTUSIONS 

A contusion is a bruise caused by a blunt force such as 
a kick, blow or crushing injury. There is no wound in the 
skin but a subcutaneous laceration with stretching and tearing 
of many minute blood vessels. 

Contusions are often associated with wounds and other 
injuries. Head injuries are always dangerous and should 
be treated for fracture of the skull. Injuries to the chest 
are usually followed by severe shock which may be profound. 
A blow to the pit of the stomach spoken of as a “blow to 
the solar plexus” may cause instant death. The danger of 
internal injury is also very great in blows, etc., on the 
abdomen and symptoms of such an injury should always be 
watched for. A fracture of a bone may also occur without 
external signs. 

The symptoms of a contusion are pain, swelling, heat, dis¬ 
coloration and loss of function. The part is first red, then 


CONVALESCENCE 


as the blood stagnates, blue-black, changing to violet, green, 
brown and yellow as the hemoglobin is gradually decomposed 
and the products finally reabsorbed. The blood works its 
way slowly to the skin. The discoloration may appear within 
a few hours or not for hours or days, depending upon the 
blood supply of the part and the depth of the injured vessel. 
Where the tissue is loose, as in the eyelids, a “black eye” 
develops almost immediately, whereas on the thighs or 
buttocks the thick muscles and dense fascia may prevent 
its appearance for days, when the cause of the bruise may 
be entirely forgotten. 

When bleeding occurs from a large vessel forming a 
circumscribed collection of blood enclosed by the tissue, it 
is called a hematoma—a blood tumor. 

The treatment consists in the local treatment to control 
the bleeding and restore the vitality of the part and the 
treatment for shock. The local treatment depends somewhat 
upon its extent—rest, elevation where possible and applica¬ 
tions of heat or cold are used. A splint may be used to 
secure rest. Cold compresses may be used in the early stages 
and when the bruise is not extensive. Evaporating lotions 
such as lead and opium are cooling and give great relief 
when left uncovered to allow for evaporation. Wet dressings 
of lead and opium are also used. They are mildly antiseptic, 
astringent and soothing. Wet dressings of aluminium acetate 
are sometimes used. Aluminium acetate is mildly astringent 
and antiseptic. 

Magnesium sulphate solution acts as an anesthetic and 
relieves pain. An ice-bag as an application of cold must be 
used with extreme care. Its weight causes discomfort and the 
intense cold may cause gangrene when the tissues are badly 
injured and thus vitality lowered. All extensive bruises are 
best treated by hot antiseptic solutions. The danger of 
infection in the weakened tissue should be kept in mind. 

After cold applications have controlled the bleeding, they 
are no longer desirable. The part should be bandaged 
with even pressure and heat applied to aid absorption and 
restore the vitality of the part. Massage may be used later 
to restore the vitality. It should never be used soon after 
severe bruises because of the danger of embolism. 

See Wounds. 


CONVALESCENCE 

Convalescence really means getting back, step by step, 
to normal responsibilities and the further away a patient’s 
mind can be directed from the idea of illness, so much 
quicker will the progress be. If overtired, patients become 
discouraged, irritable and depressed, all because they have 


CONVULSIONS 

done more than physical strength allows. Two steps forward 
and one step back is discouraging—rather one and a half 
steps forward and no overtiredness. 

Entertaining convalescent children. —To meet the need 
during a child’s convalescence, it is equally necessary to 
prevent their being overtired and overentertained as in 
the case of adults. Do not give too many toys at one time. 
Let the child get all the diversion he can from one and 
when tired of that, take it away and give another. A 
child will play with much less nerve strain when he is 
evolving things himself than when closely observing what 
another does. 


CONVULSIONS 

Convulsions are violent, involuntary muscular contrac¬ 
tions. The contractions may be continued or intermittent 
and may be local or general. 

Convulsions may be classified according to (i) the charac¬ 
ter of the contractions; (2) as to whether .they are local 
or general; and (3) the cause of the convulsion and origin 
of the irritation; that is, whether the convulsion is due to 
irritation or irritability of the motor centers of the brain 
or of the spinal cord. 

Character of the Contractions. —Contractions which are 
intermittent, the muscles alternately contracting and relaxing, 
are called clonic. The movements are abrupt and jerky. 

Contractions which are long continued are called tonic. 

Both tonic and clonic contractions may occur in the same 
convulsion and frequently follow each other. 

Coordinate contractions are clonic contractions in which 
the movements seem purposeful. They are an exaggeration 
of the natural contractions. 

Cause and Origin of the Irritation. —Convulsions which 
result from excessive irritation or irritability of the motor 
centers of the brain are characterized by loss of conscious¬ 
ness. They are called epileptiform convulsions and are com¬ 
monly spoken of as fits. The contractions are chiefly clonic 
but may be preceded by a short tonic contraction. The con¬ 
vulsions are general. 

Epileptiform convulsions may be caused by: (1 Idiopathic 
epilepsy; (2) injuries to the head with concussion, laceration 
of the brain, or pressure on the brain from hemorrhage or a 
fractured skull; (3) organic brain diseases due to meningitis, 
syphilis, tumors, abscesses or apoplexy; (4) toxic substances 
in the blood as in the acute infections, alcoholism, uremia 
and in poisoning by certain drugs; (5) reflex irritation as in 
the convulsions in young children resulting from gastric 
disturbances, intestinal parasites, teething, an adherent prepuce, 


CONVULSIONS 


the onset of an acute disease, or any condition accompanied 
by a rise in temperature; (6) cerebral anemia resulting from 
a profuse hemorrhage or from certain forms of heart disease. 

Tetanic convulsions may result from:—(i) Tetanus or lock¬ 
jaw; (2) cerebrospinal meningitis; (3) strychnine-poisoning; 
(4) tetany. 

Hysterical convulsions are manifestations of hysteria, a 
disease of the nervous system. The convulsions may simulate 
those of epilepsy or any of the above forms so are not 
characteristic. They differ from those of epilepsy and other 
convulsions originating in the centers of the brain in that 
while the eyes are closed and the patient may seem to be 
unconscious he seldom loses consciousness completely and 
will often respond to suggestion. For instance, a patient 
may recover on hearing a suggestion to pour a bucket of 
cold water over him. Suggestion is one of the methods used 
in treating hysterical patients. Other points of differentia¬ 
tion are that the movements are usually tonic, not clonic, 
the pupils react to light, there is no involuntary passage of 
urine, biting the tongue, frothing at the mouth, change in 
the pulse or in the color of the face. The patient may fall 
but in a place and manner in which he cannot hurt himself. 
In convulsions from other causes, a patient may receive 
severe injuries in falling. The attacks of hysteric convul¬ 
sions are usually not sudden; there may be screaming, 
laughing or crying during the attack and it may be more 
prolonged than in epilepsy and other forms. After recovery, 
the patient is often excited, restless, and emotional, and may 
laugh or cry, whereas in epilepsy the patient usually sleeps 
for an hour or more after the attack. 

Eclampsia is a sudden attack of general convulsions 
usually of the epileptiform type. The term is applied to 
the convulsions occurring in infancy as a result of reflex 
irritation, and to those occurring in women during preg¬ 
nancy, labor, or the puerperium as a result of toxic materials 
retained in the blood. 

The Treatment. —Coolness, presence of mind, and prompt¬ 
ness in action are necessary in the treatment of convulsions 
from any cause. The patient should be placed in the recum¬ 
bent position with his head slightly elevated and in a place 
(in bed if possible) where he cannot hurt himself. His 
movements may be guided so as to prevent injury to himself 
but should not be restrained. A gag should be placed 
quickly between the teeth to prevent him from biting his 
tongue. His clothing should be loosened and fresh air 
admitted freely. 

A patient should never be left alone while in a convulsion. 
The symptoms of the attack should be carefully noted and 


COOKING 


reported to the doctor on his arrival. Further treatment must 
depend upon the diagnosis and will be ordered by the doctor. 

The chief points to observe about convulsions as an aid 
to diagnosis are as follows: 

1. The time of the attack. 

2. The onset of the attack, whether sudden, or preceded 
by a warning, or by nervous or emotional disturbances. 

3. The character of the contractions, whether tonic, or 
clonic, whether one form follows the other, or whether 
the movements are coordinate or not. 

4. The area involved, whether local or general, and if 
local the part affected. 

5. The muscles first affected and the order in which other 
muscles are involved. 

6. The frequency and duration of the convulsion. 

7. Whether the patient is hypersensitive, conscious, semi¬ 
conscious, or totally unconscious. 

8. Relaxation of the sphincters with involuntary move* 
ments of urine or stools. 

9. The appearance of the eyes, whether closed or open, 
fixed, squinting, the pupils dilated, contracted or irregular. 

10. The appearance of frothing at the mouth. 

11. Any change in the pulse, respiration, or the color, or 
expression of the face. 

12. The condition of the patient following the convulsion. 

Convulsions in children have the same significance as a 

chill in an adult. They may mark the onset of an acute 
infectious disease such as scarlet fever or pneumonia, or 
may be a symptom of cerebral diseases such as meningitis, 
hydrocephalus, a brain tumor or abscess; or may be due to 
some minor cause such as teething, or constipation, or to 
violent emotion in a nervous, excitable child. Owing to 
their unstable nervous system minor causes or irritation may 
cause a convulsion in children. 

The Treatment .—A doctor should be summoned immediately. 
During the convulsion the child should be placed in a hot 
bath (98° to 105° F. for 1 to 2 minutes) or a mustard 
bath or pack in order to relax the muscles. Cold applica¬ 
tions should be applied to the head. When the attack is due 
to gastro-intestinal disturbances a lavage may be given and 
a hot enema followed by a purgative—castor oil is commonly 
used. The child should be watched closely following the 
convulsions and preparations made ready for repeating the 
treatments, as the attacks are apt to recur. 

COOKING 

Effect of Cooking upon Food. —It has been proved that 
the diet of man can be made more effective for his needs 


COOKING, TIME-TABLE TOE 


if the raw materials are prepared before they are eaten. 
This preparation of food is known as cooking. Food is 
cooked, then, for certain definite reasons, namely: (i) to 
increase its digestibility; (2) to destroy the parasites and 
harmful bacteria which may infect it; and (3) to stimulate 
the appetite by developing its flavor and appearance. 

See Foods, Preparation of. 

COOKING, TIME-TABLE FOR 

The following time-table should be used in the preparation 
of food to insure correct cooking: 


Time-Table 


Material 

Method 

Time 

Beef (fresh) . 

Boiled 

4 to 6 hours 

Corned beef . 

Boiled 

4 to 7 hours 

Shoulder or leg of mutton .. . 

Boiled 

3 to 5 hours 

Shoulder or leg of lamb . 

Boiled 

2 to 3 hours 

Fowl (4 to 5 pounds) . 

Boiled 

2 to 4 hours 

Chicken (3-lb. hen) . 

Boiled 

1 to 1 Yi hours 

Ham . 

Boiled 

4 to 6 hours 

Lobster . 

Boiled 

2s to 30 minutes 

Salmon (whole) . 

Boiled 

10 to 15 minutes 

Vegetables: 



Asparagus . 

Boiled 

25 to 30 minutes 

String beans. 

Boiled 

1 to 2 hours 

Dried beans . 

Boiled 

1 to 2 hours 

Beets (new) . 

Boiled 

45 minutes to 1 hour 

Beets (old) . 

Boiled 

4 to 6 hours 

Beet greens . 

Boiled 

1 hour or more 

Brussels sprouts . 

Boiled 

15 to 20 minutes 

Cabbage (for creamed cab- 



bage) . 

Boiled 

10 to 15 minutes 

Cabbage . 

Boiled 

30 to 80 minutes 

Cauliflower . 

Boiled 

1 to hours 

Celery . 

Boiled 

2 to 2J/2 hours 

Corn (green) . 

Boiled 

10 to 20 minutes 

Onions . 

Boiled 

45 minutes to 2 hours 

Oyster plant (salsify) . 

Boiled 

45 minutes to 1 hour 

Parsnips . 

Boiled 

30 to 45 minutes 

Peas . 

Boiled 

20 to 60 minutes 

Carrots . 

Boiled 

20 to 40 minutes 

Potatoes (white) . 

Boiled 

20 to 35 minutes 

Potatoes (sweet) . 

Boiled 

20 to 30 minutes 

Rice . 

Boiled 

20 to 30 minutes 

Squash . 

Boiled 

20 to 30 minutes 







































COOKING, TIME-TABLE FOB 


Time-Table 


Material 

Method 

Time 

Spinach . 

Boiled 

15 to 20 minutes 

Tomatoes (stewed) . 

Boiled 

20 to 30 minutes 

Turnips . 

Boiled 

45 to 60 minutes 

Coffee . 

Beef (ribs or loin, rare) per 

Boiled 

3 to 5 minutes 

pound . 

Beef (ribs or loin, well done) 

Roasted 

8 to 10 minutes 

per pound .. 

Roasted 

12 to 15 minutes 

Beef (rolled, rare) per pound. 
Beef (rolled, well done) per 

Roasted 

12 to 15 minutes 

pound . 

Roasted 

15 to 20 minutes 

Leg of lamb per pound . 

Roasted 

10 minutes 

Leg of mutton per pound .... 
Mutton (stuffed, forequarter) 

Roasted 

15 minutes 

per pound . 

Roasted 

15 to-20 minutes 

Lamb, well done, per pound. . 

Roasted 

15 to 18 minutes 

Veal, well done, per pound... 

Roasted 

20 to 25 minutes 

Pork, well done, per pound... 

Roasted 

20 minutes 

Chicken, well done, per pound 

Roasted 

15 to 20 minutes 

Turkey (8 to io pounds) .... 

Roasted 

3 hours 

Ducks (domestic) . 

Roasted 

1 to i l / 2 hours 

Ducks (wild) . 

Roasted 

20 to 30 minutes 

Small birds . 

Roasted 

15 to 30 minutes 

Large fish . 

Roasted 

45 minutes to 1 hour 

Fish steaks, stuffed . 

Roasted 

45 minutes to 1 hour 

Steak, i inch thick. 

Steak, i inches to 2 inches 

Broiled 

6 to 12 minutes 

thick . 

Broiled 

15 to 20 minutes 

Lamb chop or mutton chop. . . 

Broiled 

10 to 15 minutes 

Quail . 

Broiled 

12 to 20 minutes 

Squab . 

Broiled 

12 to 20 minutes 

Spring chicken (broiler) . 

Broiled 

20 to 40 minutes 

Shad . 

Broiled 

12 to 15 minutes 

Bluefish . 

Broiled 

12 to 15 minutes 

Bread (loaf) . 

Baked 

45 minutes to 1 hour 

Rolls (risen) . 

Baked 

20 to 25 minutes 

Biscuits . 

Baked 

10 to 12 minutes 

Muffins. 

Baked 

20 to 25 minutes 

Sponge cake (loaf) . 

Baked 

45 to 60 minutes 

Layer cake . 

Baked 

20 to 25 minutes 

Cookies . 

Baked 

10 to 15 minutes 

Custards . 

Baked 

20 to 60 minutes 

Steamed brown bread . 

Steamed 

2 to 3 hours 

Pastry. 

Baked 

30 to 45 minutes 









































COOKING, TIME-TABLE FOR 


Time-Table 


Material 

Method 

Time 

Potatoes . 

Baked 

30 minutes to 1 hour 

Scalloped dishes. 

Baked 

20 minutes 

Steamed puddings . 

Baked 

1 to 4 hours 

Plum pudding . 

Baked 

2 hours (after steam¬ 
ing 10 hours) 


COPAIBA 

An oleoresin obtained from the sap of a tree growing in 
Brazil and other South American countries. 

When applied locally, it reddens the skin or mucous 
membranes. 

When taken internally, it checks the formation, and aids 
in the expulsion of gas from the intestines, and acts as 
a cathartic. It is absorbed from the stomach and intestines, 
but produces no effect, except a slight reduction of tempera¬ 
ture. 

It is eliminated by the urine and expired air, acting as 
an antiseptic on the mucous membranes of the organs 
through which it is excreted. It slightly increases the flow 
of urine. 

It is used as an antiseptic for gonorrhea, cystitis, etc. 

Large doses often cause nausea and vomiting and various 
rashes, such as urticaria. 

Preparations 

Copaiba; dose io to 30 minims. 

Oil of Copaiba; dose 10 to 30 minims. 

COPPER (CUPRUM) 

Copper is a metal, some salts of which are occasionally 
used as drugs. 

Preparation 

Copper Sulphate (blue vitriol or blue stone); dose as 
an astringent V\ to 2 grains, as an emetic 5 to 10 grains. 

It is used principally to contract the granulations which 
form in the eyelids in trachoma, an infectious disease of the 
eyelids. 

It is also used to produce vomiting, as an astringent, and 
occasionally to destroy tissue (escharotic action). 

CORD, LIGATURE OP 

See Labor, Management. 

CORNSILK 


See Zea. 














CORYZA 


CORYZA (COLD IN THE HEAD) 

This is an inflammation of the mucous membrane of the 
nose and the throat, and often of the eyes as well, with a 
very free discharge of mucus which may extend to the 
trachea or even bronchial tubes. 

Treatment. Give the patient a warm bath and a laxa¬ 
tive and keep in bed for a few days. Some relief is obtained 
by inhaling steam from a solution of benzoin (i teaspoonful 
to a pint of water—or the same amount of pulverized 
camphor) and for this treatment a paper cone can be made 
of newspaper or brown paper to extend from the kettle to 
the patient. Gargling the throat with an astringent, such 
as lemon juice, glycerin, water and soda or very hot saline 
solution, may provide relief. 

Give fluid drinks, such as hot lemonade and plenty of 
water. To allay irritation of the surface of the throat, 
which frequently causes coughing, give the white of egg 
with a little lemon juice in it. Apply a mustard paste, or 
a flaxseed poultice over the chest and throat, or rub on 
camphorated oil, or turpentine and oil in equal parts. (This 
treatment must be stopped before the skin is too much 
irritated.) Give a light but nourishing diet. Care is needed 
to build up the system afterwards to prevent a repetition of 
the same condition. 


COTARNINE 

See Stypticin. 

COUGHS AND COLDS 

Prevention of coughs and colds 

One of the best precautions against taking cold is the 
plentiful use of cold water. A good plunge bath every 
morning, or at least sponging the throat, arms, and chest 
with cold water for a few moments, will cause the blood 
to circulate freely and brace up the system. Breathing 
through the nose instead of the mouth, when in the open 
air, will often prevent sore throat. Damp skirts and wet 
shoes should be changed immediately, and if the feet are 
cold and wet, dip them into cold water for a minute, and 
rub briskly with a rough towel. The passages of the nose 
and throat should be kept thoroughly cleared so that the 
air can circulate freely through them, and thus prevent 
any clogging that might cause catarrh. 

Care of coughs and colds. —Once the symptoms of a 
cold really establish themselves, there are some simple reme¬ 
dies that can be tried to overcome it. The first thing which 


COUGHING 


all doctors recommend is a good cathartic to clear out the 
system and reduce the feverish symptoms. This is always 
best taken at night so as to act the first thing in the morning. 
Almost every one has some simple home remedy he is accus¬ 
tomed to use, and it should be followed in the morning by 
a Seidlitz powder or one of the many mineral waters in 
general use. With children a dose of castor oil is the safest 
and best remedy to use, especially when there is any sign of 
croup. As a rule, calomel acts well with adults, in overcoming 
a cold; either in doses of one-tenth of a grain tablets, two 
taken every fifteen minutes until ten or twelve have been 
consumed; or one-quarter grain tablets, one every half hour 
for four doses. Calomel should always be followed in a 
few hours by a mineral water or salts of some kind to 
prevent its remaining in the system. 

When there are any feverish symptoms with the cold, as 
headache, flushed cheeks, skin dry and hot, etc., a hot 
mustard foot-bath will draw the fever down from the head 
and promote free perspiration. After the foot-bath, tuck 
your patient in bed with hot water bags and give him a 
hot drink of any kind, heat being the principal object; 
either milk, bouillon, or lemonade. In the morning a cold 
sponge over arms and chest, and a generous dose of mineral 
water, will often be the final touch necessary to drive the 
cold out of the system. Camphor taken in some form at the 
very beginning of a cold is most helpful; it can either be 
taken in camphor pills, in the rhinitis tablets which contain 
a good deal of camphor, or spirits of camphor, ten drops on 
a lump of sugar. 

Five or six grains of quinine, taken at bedtime, and again 
in the morning, is also of great service in some cases in 
the commencement of a cold. 

COUGHING 

Coughing is a violent expiration preceded by a deep in¬ 
spiration. When a patient coughs, there is a deep inspiration 
at first, followed by violent contractions of the abdominal 
muscles, which push the abdominal organs up against the 
diaphragm. The diaphragm then presses up against the 
lungs, and violently expels the air and secretions which they 
contain. The expiration is violent, because the larynx is 
closed at the time when the expiration occurs. 

Coughing is a reflex act. It occurs when an object lodges 
in the larynx, when the 'bronchi are red and inflamed, or 
when they contain a great deal of mucus. These affect the 
nerve endings in the bronchi, which send impulses along the 
vagus nerves to the respiratory center in the medulla. 


COUNTERIRRITANTS 


This center at once sends back impulses to cause violent 
expiratory contractions of the diaphragm, and coughing 
results. 

COUNTERIRRITANTS 

The Meaning of Counterirritant. —Counterirritants are 
“remedies which by irritation of the skin are intended to 
counter or check deeper-lying affections.” 

The counterirritants used to produce varying degrees of 
irritation are: 

i. Rubefacients .—These are agents used to produce the 
first degree of irritation which, as the name implies, means 
irritation sufficient to cause reddening of the skin. The 
agents used are: 

(a) Physical agents which may be local or general applica¬ 
tions of heat applied for a brief or prolonged period. 

Local applications of dry heat may be in the form of a 
hot-water bag, baking, electric light and the cautery. 

Local applications of moist heat may be in the form of 
poultices, compresses, stupes, a hot foot-bath, an arm-bath, 
a sitz bath, and irrigations. 

General applications of dry heat may be in the form of 
a hot-air bath or an electric bath. 

General applications of moist heat may be in the form of 
vapor baths, hot packs or hot tub-baths. 

(b) Mechanical agents, such as friction, percussion, pres¬ 
sure, or suction. 

(c) Chemical agents, such as mustard, turpentine, or iodine, 
etc. 

a. Vesicants are the agents used to produce the second 
degree of irritation, which, as the name implies, means the 
formation of a vesicle or blister. An example of a vesicant 
is the cantharides plaster. 

3. Escharotics are the agents used to produce the third 
degree of irritation which, as the name implies, means the 
formation of an eschar, which is a slough or the actual 
death of tissue. Examples would be strong acids or alkalies, 
copper sulphate, silver nitrate, or the cautery. 

CRABS 

See Lice. 

CREOLIN 

Creolin is an emulsion of cresol. It is used in 1 to 5 
per cent, solutions to disinfect sinks, excreta, toilets, etc. 
It is also used in ^ to 1 per cent, solutions for vaginal 
douches, and for bladder irrigations. Creolin solutions must 
be made up with warm water. 


CRETINISM 


CREOSOTE 

Creosote is a substance made by distillng wood tar. Its 
action is due to the guiacol which it contains. 

The action of creosote is similar to that of carbolic acid; 
it is not as strong an antiseptic as carbolic acid, but it is 
more poisonous. It produces the following effects: 

1. Locally, it relieves pain and acts as an antiseptic. 

2. When given internally, it acts as an intestinal anti¬ 
septic. 

3. It is absorbed from the intestines and it then lowers 
temperature, increases the perspiration and all the secretions, 
especially the bronchial sections. 

4. It is eliminated by the lungs and urine. It acts as 
an antiseptic in both of these organs. 

Creosote is used principally as an antiseptic in pulmonary 
tuberculosis or lung abscesses; to destroy the bacteria in 
the lungs. It is often given by inhalation. 

Preparations 

Creosote; dose 1 to 5 minims. 

Creosote Water (Aqua Creosoti) ; dose 30 minims to 2 
drams. 

This contains 1 per cent, of creosote. 

Creosote Carbonate (Creosotal); dose 5 to 30 grains. 

See Guiacol, and Carbolic Acid. 

CRESOLS 

There are a number of oily substances which are exten¬ 
sively used as antiseptics, and are chemically closely related 
to carbolic acid. 

They are oily solutions, which do not dissolve readily in 
water and are used as emulsions or in soapy solutions. 
The antiseptic, physiological and poisonous actions of all of 
them are like those of carbolic acid. 

Preparations 

Cresol; dose 1 minim. 

This is a mixture of cresols. 

Compound Solution of Cresol (Liquor Cresolis Composi- 
tus). This is a 50 per cent, solution of cresol in soap solu¬ 
tion. It is used in dilute solutions as a disinfectant. 

Tricresol. This is a mixture of cresols. 

Kresamine. This contains 25 per cent, of tricresol and 
is used as an antiseptic like phenol and as an ointment for 
skin diseases. See Carbolic Acid. 

CRETINISM 

See Thyroid Gland, Diseases ok. 


CROTON CHLORAL HYDRATE 


CROTON CHLORAL HYDRATE, OR BUTYL CHLORAL 
HYDRATE 

This resembles chloral in its effects; it is not as efficient 
but the effects are more lasting. It particularly lessens 
the sensations carried from the face by branches of the 
fifth cranial nerve. It is therefore frequently used to 
relieve the intense pain of trifacial neuralgia (“tic douleu- 
reux”). Dose, 5 to.20 grains. See Chloral Hydrate. 

CROTON OIL (OLEUM TIGLII) 

Croton oil is a fixed oil; its active principle is an acid, 
crotonoleic acid. 

Croton oil acts principally on the small intestine; pro¬ 
ducing in one or two hours after it is given, frequent large 
fluid stools with severe griping pains. The violent move¬ 
ments of the bowels continue for about twelve to fifteen 
hours, and each stool is accompanied by severe griping, 
so that the patient soon becomes exhausted. 

The dose of Croton Oil (Oleum Tiglii) is 1 to 2 minims. 

Administration 

Croton oil is given principally in cases where the patient 
is unable, or unwilling to swallow. In cases of apoplexy, 
for instance, when the patient is unconscious; or in an 
attack of mania, when the patient is so excited that he is 
unwilling to swallow medicine. 

In such cases, one or two drops of croton oil dissolved 
in glycerin or olive oil, are placed on the back of the 
tongue with a spoon. The oil may also be given on a piece 
of sugar, or on a few bread crumbs. 

Croton oil is occasionally applied to the skin, to produce 
redness, and thereby to relieve congestion of deeper organs. 
A few drops of croton oil are poured on a piece of flannel, 
and rubbed on the skin. It may also be added to olive oil, 
or to a liniment, and applied by rubbing on the skin. 

CROUP 

Croup is a contraction of the muscles at the entrance 
to the trachea from the throat. 

Symptoms: The chief symptoms are a noisy, “croupy” 

cough, difficulty of drawing air into the windpipe and strain¬ 
ing for breath. 

There are two distinct sorts of croup; one is the ordinary 
catarrhal croup and the other a membranous croup and 
very serious. The initial symptom—difficulty in breathing 
-—is the same in both. Fortunately the latter is compara¬ 
tively rare, but if a child shows symptoms of croup look in 
the throat immediately and see if there is any sign of mem- 


CRY 




brane forming there. If so, report it to the physician 

at once. 

Treatment: Give an emetic of a teaspoonful of syrup 

of ipecac, a little alum on sugar, or one teaspoonful of 
melted vaselin. The finger can be put down the throat to 
induce vomiting. Place hot, moist cloths around the neck 
and down the middle of the chest, keeping a warm hot 
water bottle over them, or a flaxseed poultice can be 
applied there. 

Hot, moist air to breathe relaxes the muscles and may be 
provided by the following methods: 

1. Place a screen around the crib and cover the crib and 
screen with a sheet. If there is a croup kettle (this is a 
kettle with a long funnel spout) use this over some heating 
apparatus (alcohol or gas lamp) near the bed, being careful 
to avoid the danger of fire. Let the steam escape through 
the funnel under the sheet into the enclosed space. Lacking 
a croup kettle, use an ordinary kettle with a paper funnel 
or a child’s bugle attached to the spout. 

2. Take the child to the bathroom and turn on the hot 
water so that the resulting steam may be breathed. 

3. Or take the child to the kitchen where a temporary 
bed may be made on a table or chairs near the stove, with 
an umbrella and sheet over it to provide an enclosed space. 
Have the steam from the kettle directed into this space by 
means of an improvised paper funnel. 

A mustard foot-bath is sometimes very effective. 

Be careful in giving the treatments outlined above that the 
child does not take cold as the effort of difficult breathing 
causes excessive perspiration. Afterwards give a laxative. 
The diet for the next few days should be very light. 

CRUTCHES 

See Amputations. 

CRY 

Significance of a child’s cry. 

Crying immediately after coughing shows that the cough 
has caused pain in the chest. 

Incessant crying in a very young child is a sure indica¬ 
tion of pain or hunger. If from hunger, the child will stop 
crying as soon as he is fed. 

When there is pain in the ear the child will frequently 
put up his hand to his ear. 

When there is pain in the abdomen the cry will be very 
loud, and the child will draw his legs up against the 
abdomen. 


CUBEBS 


Sharp screams at intervals, followed by low moans, may 
be a sign of brain disease. 

CUBEBS 

A powder made from the unripe fruit of the Piper 
Cubeba, an East Indian Plant. 

The action is the same as that of Copaiba. 

Preparations 

Fluidextract of Cubebs; dose io to 30 minims. 

Oleoresin of Cubebs; dose 10 to 15 minims. 

Oil of Cubebs; dose 5 to 15 minims. 

See Copaiba. 

CUMULATIVE ACTION 

Some drugs are excreted much more slowly than they are 
absorbed. If such drugs are administered for any length 
of time, a part of each dose always remains in the body. 
After prolonged administration so much of the drug may 
accumulate in the body that poisonous effects may occur. 
The poisonous effects that result from a drug accumulating 
in the body as a result of the elimination being slower than 
the absorption are called cumulative effects. 

Drugs which are apt to cause cumulative effects when 
given continuously, should be administered with periods of 
intermission during which the drug is stopped, or the dose 
should be gradually reduced. For example, digitalis, which 
may cause cumulative effects, should be given in diminishing 
doses or with periods of intermission when it is discontinued 
entirely. 

CUPPING 

Dry cupping is a means of producing a counterirritant 
effect, through suction, by the application to the skin of 
specially made cups (Biers’), or small glasses in which a 
vacuum is created by heating the air contained in them. 
When the air is heated it expands and part of it escapes— 
at this point the glass is placed on the skin. As the air 
cools it condenses, so that a partial vacuum forms in the 
glass into which the tissues beneath are drawn. These tissues 
are thus expanded, their blood vessels are dilated so that an 
increased amount of blood flows through them. In this way 
the circulation is stimulated and congestion relieved in the 
deeper tissues. The Biers’ cups are glasses of various 
shapes, provided either with a rubber bulb by which air 
may be exhausted, or fitted with a valve or stopcock to which 
a small exhaust pump may be attached to exhaust the air 
in the glass. 


CUPPING 


Conditions and Purposes for which Cupping is Used: 

Cupping may be applied to the following areas: 

1. To the chest, either posterior, anterior or both, in 
asthma, edema of the lungs, or pneumonia with cyanosis in 
order to relieve -pain, dyspnea and congestion or stasis of 
blood. 

2. To the lumbar region to relieve congestion or stasis 
in the kidney and to relieve suppression. 

3. To inflamed areas such as boils, etc., in order to stimu¬ 
late the circulation in the part and cause an active hyperemia. 

Cupping is contraindicated in acute pleurisy or peritonitis 
on account of the danger of injuring the parietal serous 
membranes. 

Method of Procedure. —Preparation of the patient .—It is 
particularly important that this treatment should be per¬ 
formed as quietly, reassuringly, and as skilfully as possible. 
The thought of being burned is always an alarming one, 
so that, if the patient is conscious or not so depressed or 
toxic as to be indifferent to what is being done, he should 
be reassured on this point and also assured of the relief 
and comfort which usually result. 

Only the necessary area should be exposed and every pre¬ 
caution taken to prevent chilling, especially of the arms and 
shoulders when cupping the chest. The feet and body should 
always be warm. 

As the patient is frequently in a very serious condition, 
he should be disturbed as little as possible, and all exertion 
on his part avoided. 

When he is not allowed to sit up and can breathe only 
when lying on his side, he is very carefully turned from 
side to side for the application. In either case watch his 
color, pulse and respiration closely. 

The necessary articles are usually brought to the bedside 
on a tray. They consist of six or eight cupping glasses, an 
alcohol lamp, matches, absorbent cotton, a glass rod, alcohol, 
a glass to contain the alcohol, a piece of old blanket to 
extinguish the flame and two towels. One or two blankets 
will be required. The cupping glasses should have thick, 
smooth rims and should be clean and dry. They are placed 
conveniently on a folded towel (to avoid noise) on the side 
of the table near the patient. The articles on the tray are 
arranged conveniently and so that the lighted swab will not 
pass over the open glass containing the alcohol. This 
glass should be distinct in shape from the cupping 
glasses. 

The greatest care must be taken to avoid burning the 
patient or setting fire to the bedding, etc. While such a 
calamity might never occur, the results are so serious and 


CURARA 


at least so alarming, that it is necessary to take the following 
precautions: 

. (i) Have blankets so disposed around the immediate area 
that no cotton or linen is ex-posed to the danger of fire. 

(2) In placing the articles on the tray, the alcohol should 
be in the farthest corner from the patient, and away from 
the lamp. 

(3) The cotton which is wound around the applicator or 
glass rod must be thoroughly moistened with alcohol so that 
the flame is due to burning alcohol, and not to cotton, shreds 
of which would be apt to fall and burn the patient. 

(4) Avoid using too much alcohol so that it drops or 
runs along the rod, spreading the flame. 

(5) Never use the cotton if charred. 

(6) Don’t have too large a flame as this will heat the 
rims of the glasses. Don’t heat the rims, heat the air inside. 
There is no danger of burning if the flame is inside the 
glass, not around the rim. 

(7) The glasses should be clean. 

In applying the cups never leave small areas untreated and 
thus exposed to chilling. The vessels of the whole area 
should be evenly dilated. The cups, however, must not be 
applied v r here a former cup has made a deep mark. 

The duration of the treatment is ordered and is usually 
from ten to twenty minutes, during which repeated applica¬ 
tions are made until the desired result is obtained. In remov¬ 
ing a glass, always insert your finger to allow the escape of 
air so that it may be removed w-ithout discomfort to the 
patient. Reddening of the part indicates the desired result 
has been obtained. Never allow the part to become a dusty 
red. 


CURARA 

Curara is an arrow poison which is used by the South 
American Indians. It is made from the bark of various 
trees, such as the Strychnos toxifera. Its active principle 
is an alkaloid, curarine. It is rarely used in practical medi¬ 
cine, but it is frequently used in animal experiments. 

Curara paralyzes the nerve endings of all the muscles, 
thereby lessening their contractions. It causes a rapid, 
weak pulse, by making the heart beat faster as a result of 
the paralyzed nerve endings of the vagus nerve in the heart, 
which curara causes. The blood pressure is lowered, how¬ 
ever. 

It increases peristalsis and all the secretions. Curara is 
occasionally used to lessen the spasms of tetanus, hydro¬ 
phobia, etc., but its use is dangerous on account of its 
weakening action on the heart. It is given in doses of J 4 of 




CYSTS 

a grain; or curarine, the alkaloid, is given in doses of 1/200 
to Vioo of grain. 

CURETTAGE 

See Uterus. 

cusso 

Cusso, kousso or brayera, is the female flowers of Hag- 
enia abyssinica or Brayera antbelmintica, an Abyssinian 
tree. Its active principle is a neutral resin, kosotoxin, but 
it also contains tannic acid, a volatile oil and other sub¬ 
stances. 

Cusso has a bitter taste and contracts mucous mem¬ 
branes. Its principal effect is to destroy tape worms. 

Large doses occasionally cause nausea, vomiting, diarrhea 
and rarely, collapse with an irregular pulse. 

Preparations 

Cusso is usually given in doses of half an ounce of the 
powdered flowers in water as a suspension. 

Fluidextract of Cusso; dose 1 to 4 drams. 

No cathartic is required after cusso, though the usual 
preparatory methods should be carried out. 

See Anthelmintics. 

CYANOSIS 

Cyanosis is a blue color of the skin. This is caused by the 
dark color of the blood in the superficial blood vessels. 
This dark color is due to the methemoglobin which the 
blood contains, as a result of an excess of carbon dioxide. 
It usually results when the patient does not get enough 
oxygen into the lungs to purify the blood. 

CYCLOFORM 

See Anesthesia. 

CYPRIPEDIUM 

Cypripedium is obtained from the roots and underground 
stems of Cypripedium pubescens or lady’s-slipper, and from 
Cypripedium parviflorum or moccasin plant, two American 
plants. The active principle of these plants is a volatile oil. 

It relieves nervousness and quiets the patient. It has 
been used as a substitute for valerian. Dose, of the fluid- 
extract, 15 to 30 minims. 

CYSTITIS 

See Bladder Irrigation, and Bladder Instillation. 

CYSTS 

See Ovary. 


D 


DAKIN’S SOLUTION 

Dakin’s Solution is a specially prepared solution of sodium 
hypochlorite, containing exactly 0.45 to 0.50 per cent, of 
sodium hypochlorite. If the percentage of hypochlorite is 
less, the solution is inactive; if it contains more, the solu¬ 
tion is very irritating. The solution must be absolutely 
neutral in reaction when tested with phenol-phthalein. 

Action. Dakin’s Solution is one of the best antiseptics 
now in use. Its antiseptic power is about fifteen times that 
of carbolic acid; yet it does not injure the young growing 
tissue cells, and consequently it does not retard healing as 
do most other antiseptics. 

Carrel-Dakin Method of Treatment of Wounds 

A fresh, exactly neutral solution is allowed to flow into 
the wound by means of a specially constructed apparatus. 
This apparatus consists of a graduated bottle and a long 
tube which terminates in a number of fine rubber tubes 
with small holes in their sides. These terminal tubes are 
placed in the wound in such a position that the fluid runs 
downward but in contact with every part of the wound, after 
being wrapped around with small pieces of gauze so as to 
keep them in place. Small pieces of gauze are placed 
between the tubes. About every two hours enough fluid is 
allowed to iun through the tubes to just fill the wound. 
This intermittent flow is essential because the solution is 
absorbed by the tissues and new fluid is then required. 

Dakin’s solution dissolves the clots and dead tissue in the 
wound. It is therefore essential that all the blood vessels 
be tied before the treatment is begun; since the dissolving 
of a clot over an open blood vessel may cause a hemorrhage. 

Since Dakin’s solution is irritating to the skin the skin 
should be covered with sterile vaselin for protection. If 
the patient complains of pain, it means that the solution is 
flowing under too great pressure or that it has not been 
properly prepared. 


DELUSIONS 


DECOCTIONS 

Decoctions are preparations of plant drugs made by boil¬ 
ing them in water and then straining the fluid. 

DELIRIUM 

Delirium is “a temporary general disturbance of con¬ 
sciousness, a perversion of the intellectual and perceptive 
faculties, characterized by confusion, by more or less transi¬ 
tory delusions and fleeting hallucinations, accompanied by 
disordered, senseless speech and muttering, and motor 
unrest.” Delirium may vary in degree of severity from a 
mild wandering type in which the patient is incessantly 
engaged in disjointed conversation with imaginary persons 
or muttering to himself, with comparatively little motor 
activity, to an excited form characterized by extreme rest¬ 
lessness and violence, shouting and attempting to escape 
from bed or room and from the tormentors created 
by his imagination who annoy and harass him, or strug¬ 
gling with the imaginary enemies and those who try to limit 
his activity and prevent his escape. The mood is variable 
and may be happy, sad, anxious, apprehensive or fearful. 
Delirium may develop as a symptom in the infectious diseases 
and toxic conditions arising from disordered physical func¬ 
tion, in alcoholic and drug poisoning, in conditions of 

exhaustion and senility, and following accidental injuries, 
trauma and surgical operations. 

DELIRIUM TREMENS 

See Alcohol. 

DELUSIONS 

Delusions are false beliefs which cannot be corrected by 
argument or experience. They may be improbable, impos¬ 
sible, inconsistent, absurd and fantastic, and are usually 

grouped as belonging to two types, the depressive and expan¬ 
sive. Among the depressive delusions are: Delusions of 

persecution, in which the patient believes himself to be the 
object of repeated acts of cruelty or annoyance; delusions 
of self-accusation in which he accuses himself of having 
committed some wrong or immoral act; delusions of reference 
in which he believes that everything which is transpiring 
about him is a direct allusion to himself; delusions of misfor¬ 
tune in which he believes that ill luck, calamity, disaster or 
accident have befallen him; and hypochondriacal delusions in 
which he believes that he is suffering from grave bodily 

disease. The expansive delusions include the “delusions of 


DEMENTIA PRiECOX 


grandeur,” in which the patient believes that he has great 
wealth, possessions, strength and influence. He may believe 
he owns all the banks, has billions of dollars, mansions of 
gold, a thousand automobiles, the beauty of Apollo, the 
strength of Samson, the authority of God and power to 
rule heaven and earth, for in fact there seems to be no 
limit to the extravagant expression. The opinion is held that 
these delusions represent in a florid form the unconscious 
desires of the patient. 

DEMENTIA PR.ECOX 

This is a term which is applied to “a group of mental 
disorders, occurring chiefly in youth or early adult life, 
showing a wide range of symptoms and leading to various 
degrees of mental deterioration which is exhibited mainly 
in the patient’s conduct and emotional reactions.” 

Physical symptoms. The physical condition may be 
below normal, with loss of appetite, loss of weight, insomnia, 
anemia, fatiguability and cyanosis of the hands and feet. 
In many cases the physical symptoms are not present. 

Mental symptoms. Orientation is not disturbed, memory 
shows no impairment and the general knowledge is well 
retained in the early stages. Hallucinations are common, 
and the attention may be so absorbed by them that little 
notice is given to what is happening in the environment. 
The stream of thought is gradually narrowed and ideas 
become scattered. Judgment is defective and delusions are 
common. The mood in the beginning may be despondent, 
but tends to become indifferent and apathetic, and expe¬ 
riences, both pleasurable and painful, fail to arouse the 
corresponding emotions. Disorders of conduct are shown 
by overactivity, impulsiveness, negativism, suggestibility, 
catalepsy, stereotypy and mannerisms. 

There are four forms of dementia praecox usually described, 
but these cannot always be sharply differentiated from one 
another and all may show quite similar terminal stages: 
(i) Simple, (2) hebephrenic, (3) catatonic, (4) paranoid. 

In the simple form the patient shows a loss of interest in 
the affairs of life, is inclined to be idle, careless of personal 
appearance, neglectful of the usual duties, and to spend 
the time in musing or day dreaming. Hallucinations and 
delusions do not occur in this form. 

The hebephrenic form is characterized by silly, meaning¬ 
less laughter without apparent cause, grimaces, peculiar 
Mtitudes, hallucinations of hearing and sight; the delusions 
are usually silly and fantastic and change often, are fre¬ 
quently of a religious and erotic nature, and may be of a 


DEMENTIA PR-ffiCOX 


depressed type and the patient will express ideas of self, 
destruction; thought is disconnected and ideas become few; 
unusual and peculiar words are used in peculiar settings, and 
speech may become monosyllabic or suppressed; the personal 
appearance becomes more untidy and bad habits are formed. 
The patient gradually becomes more listless and disinterested, 
tending more and more to withdraw from the world of 
reality and live in the fancied or dream world of his own 
creation, and mental weakness and dementia follow. 

The catatonic form is characterized by disorders of con¬ 
duct, muscular rigidity, resistiveness and negativistic tend¬ 
encies, suggestibility shown by the maintenance of given 
positions and the repetitions of the words and movements 
of others, retention of saliva in the mouth, drooling, refusal 
of food, mutism and stupor where consciousness is clouded 
and all voluntary activity suspended. Periods of excitement 
may alternate with the stupor, during which the patient 
becomes very active, tossing about and shouting the same 
words over and over with no appreciation of their meaning. 
Sudden impulsive acts may also alternate with catalepsy. 

The paranoid form is characterized by many hallucina¬ 
tions and delusions of persecution which are most improb¬ 
able, impossible and absurd. The conduct may be assaultive 
because of the delusions. 

Nursing procedures. When indicated measures should 
be taken to improve the physical condition, establish regu¬ 
larity in eating, bathing, elimination and all the usual 
activities, for in dementia praecox the habits are generally 
quite disorganized. The most important measure of treat¬ 
ment is to prevent and retard the deterioration which is 
always imminent and progressive unless it is checked by 
arousing the patient to new interests. Old and unwhole¬ 
some habits must be broken up and discontinued, and new 
and healthful ones substituted. To do this requires kind¬ 
ness, patience and firmness in large measure. Begin by 
arousing an interest in the personal appearance and correct¬ 
ing errors in daily habits. Rest periods should not be 
permitted during the day, unless prescribed by the physician; 
and lounging about in slovenly attitudes, with the head 
covered and the body in cramped positions should be pre¬ 
vented. The tendency to hide in dark and unusual places, 
to be alone, should be combated by keeping the patient in 
a group. The patient must be guarded against himself, for 
vicious habits are so easily acquired. 

If food is refused and all persuasive measures fail, the 
patient must be fed like any helpless patient, taking the 
usual methods to induce eating. If these measures fail, 
feeding by tube becomes necessary. Some patients of this 


DEMENTIA PR^COX 


group are tube fed for months, but always the effort should 
be persistently made to have them take food in the usual 
way. Bed treatment is usually prescribed for patients who 
have to be forcibly fed in order to conserve their strength. 
In the catatonic form the bladder and bowels are not as a 
rule emptied voluntarily and overdistention must be pre¬ 
vented. In this form, too, positions which are very uncom¬ 
fortable and strained are maintained for long periods, and 
the nurse should keep this in mind and change the position 
often. Brisk rubbing after baths and massage should be 
given to quicken the circulation. Cyanosis of the hands and 
feet is not uncommon, and every least scratch or abrasion 
should be carefully treated, for these may lead to serious 
infections which are healed with difficulty. Sudden, 
impulsive acts are quite common and must be guarded 
against. 

Occupations. As the tendency is strong to be idle and 
to dream, every effort should be put forth to arouse the 
patient’s interest and keep him occupied. The attention 
is so absorbed by the hallucinations and delusions that details 
are scarcely noticed and all tasks are usually poorly executed; 
but by careful, patient, persistent supervision and training, 
improvement is made, and many of these patients become 
good workers. Because of inability to adapt themselves to 
new conditions, the work should not be abruptly changed, 
for they lose interest and refuse to work at all. It is 
better to allow them to keep on with the tasks they have 
learned to perform fairly well, and gradually to include 
the new work with the old until the change can be made 
without upsetting them too much. The daily care of one’s 
room, sweeping, dusting, light cleaning, washing dishes and 
small personal articles and ironing them are some of the 
needful duties of housekeeping which they may assume 
under supervision. 

For the younger patients of this group games have been 
found useful in training attention and arousing interest, for 
the instinct of play is usually strong. Games carried out 
to music are very good, for the patient must become one 
of a group and assume social relations with the group 
which afford good training in adaptability, and the rhythm 
of the music tends to make the responses more prompt. 
Gymnastics in small groups may also be encouraged, and 
good results may be expected, for these patients are sug¬ 
gestible and imitate well. Folk dancing is a most valuable 
means of exercise and recreation. 

For the men patients of this group out-of-door occupation 
is desirable. Mowing and raking grass, sweeping walks, 
and simple gardening are tasks which may be performed by 




DENTITION 


even deteriorated eases and provide exercise as well as 
occupation. Tossing football, basketball and medicine ball 
will help to make the reactions more swift and exact. 
Gymnastic drills with wands and dumb bells will provide 
exercise and help to train attention. Other occupations 
should be provided to prevent idleness and unhealthy rumina¬ 
tions. 

Reeducation includes all the measures which are taken 
to develop the latent capacities and to correct old and 
erroneous habits. This may assume the formality of a 
class with definite instruction in which the methods are 
simple, direct and attractive. The first steps with a group 
which shows deterioration may be to get them to stand in 
line, to march to music, to form a circle and join hands and 
move about to music, to run, to skip, etc. When these 
simple exercises are done with a fair degree of proficiency 
and accuracy, others which demand more attention and 
voluntary direction may be tried. These play movements 
may alternate with elementary instruction in which a simple, 
direct appeal is made to stimulate sensation, develop percep¬ 
tion, gain attention and train memory. Self-expression 
should be encouraged and utilized and so develop out of 
what is already present other interests and responses which 
are sought for and desired in the treatment. Because 
these patients are inattentive to external impressions the 
stimulus must be strong, and something which can be seen 
and handled, blocks, squares, triangles, the blackboard, 
colored crayons, charts and models should be used. Atten¬ 
tion can always be more readily gained when the proper 
sort of bodily attitude is assumed, and many times a given 
attitude promptly calls forth the desired response. Over and 
over the same ground must be covered, and over and over 
responses which are desirable must be emphasized and 
repeated. Through these lessons the patients are awakened 
from indifference and apathy and are taught habits of tidi¬ 
ness, orderly conduct and self-reliance, and gradually 
resume interest in what is going on around them. 

DENTITION 

There are two sets of teeth developed during life: the first 
temporary or deciduous; and the second, permanent. 

Temporary teeth. —In the first set are twenty teeth, ten in 
each jaw: four incisors, two canines, and four molars. The 
cutting of the temporary teeth usually begins at six months 
and ends at about the age of two years. In nearly all cases 
the teeth of the lower jaw appear before the corresponding 
ones of the upper jaw. 


DEODORANTS 


Upper . 
Lower . 


Temporary Teeth 


Molars Canine Incisors 
. 21 2 

. 2 1 2 


Incisors Canine Molars 
2 12 


The temporary teeth are usually cut in the following order: 

Lower central incisors.6 to 9 months 

Upper incisors.8 to 10 months 

Lower lateral incisors and first molars 15 to 21 months 

Canines.16 to 20 months 

Second molars .20 to 24 months 


Permanent teeth. —During childhood the temporary teeth 
are replaced by the permanent. In the second set are 
thirty-two permanent teeth, sixteen in each jaw. The first 
molar usually appears between five and seven years of age. 

Permanent Teeth 


Upper 

Lower 


Mol. 

3 

3 


Bic. 

2 

2 


Can. 

1 

1 


Inc. 

2 

2 



The permanent teeth appear at the following periods: 

First molars. 6 years 

Two middle incisors. 7th year 

Two lateral incisors. 8th year 

First bicuspids . 9th year 

Second bicuspids.10th year 

Canines .nth to 12th year 

Second molars.12th to 13th year 

Third molars.17th to 21st year 


DEODORANTS 

Deodorants are remedies which destroy unpleasant odors. 
The chief deodorants are formaldehyde, chlorine gas, hydrogen 
dioxide, potassium permanganate, charcoal, lime, freshly 
roasted coffee, ferrous sulphate. 


See Bismuth. 


See Ovary. 


DERMATOL 

DERMOID CYSTS 


DIABETES MELLITUS 

Diabetes is a disturbance of metabolism due to the partial 
or total inability of the tissues to burn carbohydrates. As 
the blood normally carries only 100 to 120 mgm. of sugar, 
to 100 c.c. of blood, or 0.07 to o.n or 0.1 per cent, of sugar. 


















DIABETES MELLITTJS 


when not burned the excess overflow's into the urine. Diabetes 
is due to no fault or disease of the tissues, but to the 
absence of some agent which will combine w'ith the sugar 
and make it available to the tissues. It is as though a 
match or spark were needed to ignite the sugar, just as coal 
or wood, etc., must be ignited before it will burn in the 
furnace. This agent, which is deficient or absent, is thought 
to be the internal secretion of the islands of Langerhans in 
the pancreas. 

The Nursing Care and Treatment. —As the disease is 
incurable, the treatment is directed toward prolonging the 
life of the patient as many years as possible and providing 
the greatest degree of happiness, usefulness and comfort. 
The doctor prescribes the treatment, which the nurse must 
see is carried out with the most scrupulous care and intelli¬ 
gence. The nursing care is extremely important, for, the 
regulation, preparation, and serving of the diet, together 
with personal hygiene, are the great and all-important 
factors. 

The treatment —restriction of the diet and normal habits 
of living—will depend somewhat on whether the patient is 
suffering from the disease in a mild, moderate, or severe 
form. This is determined by regulations in the diet, examina¬ 
tions of the urine and blood, and by the general symptoms 
and progress of the disease. 

The Diet .—The life of the patient depends upon a proper 
regulation of the diet. Just as it is the province of the 
doctor, only, to prescribe drugs and other treatments, so it 
is the doctor, only, who should prescribe the diet for a 
diabetic patient. The nurse is there to see that, within 
the limits prescribed, the best selection is made; to avoid 
errors; to see that the food is properly prepared in the 
most digestible and acceptable form; for instance, while fat 
may be prescribed, foods fried in fat should never be 
given. She is there to see that the food is promptly and 
attractively served; to see that the restrictions and limita¬ 
tions cause as little distress as possible; that the tastes of 
the patient and variety are considered as far as the limitations 
permit; that the patient eats slowly and chews the food 
thoroughly; that the meals are as well balanced and 
resemble as nearly as possible the diet of a normal person 
for breakfast, dinner and supper, etc. She must also watch 
closely the effect of the diet on her patient. 

In order to get the best results, to avoid errors, to gain 
the cooperation of the patient and to teach him how to 
plan and prepare his diet, the nurse must understand the 
following principles which guide the doctor in regulating 
the diet: 


DIABETES MELLITUS 


The aim is to make the urine sugar-free, to increase the 
carbohydrate tolerance, to prevent progressive loss of weight 
(except in obesity and overweight), and to do so without the 
appearance of the dreaded acid intoxication. 

The body of a normal person has a limit to its ability to 
use glucose and tolerates it up to a certain point; beyond 
that it overflows into the urine. In diabetes this limit or 
tolerance for sugar and starches is more or less reduced 
according to the severity of the disease. It is most impor¬ 
tant to find out just what this tolerance is, that is, how 
much sugar or starches may be given without sugar appear¬ 
ing in the urine. The urine may be made sugar-free and 
the tolerance for carbohydrates may be increased by rest¬ 
ing the pancreas, that is, resting the function of assimilation. 
This may be accomplished by restricting the total diet, or by 
cutting down the carbohydrate and protein, or by complete 
fasting until the urine is sugar-free. Each day the urine 
remains sugar-free increases the tolerance, whereas if the 
patient is untreated, the tolerance is lowered. 

The sudden reduction of carbohydrates and protein or 
fasting may, however, lead to very serious results, that is, 
to acidosis and coma. For the body simply must have 
fuel. If it cannot utilize carbohydrates it will use fat as 
the next best fuel. But without carbohydrates fats cannot 
be completely burned, for “fats must be burned in the 
flame of carbohydrates.” Incomplete burning of fatty acids 
causes acidosis, acidosis causes coma, and coma death. 
Acidosis is indicated by the presence of acetone, diacetic or 
0-oxybutyric acid in the urine and by other symptoms to be 
mentioned later. Protein is also a contributing factor in 
acidosis. In restricting the diet, therefore (usually in all, 
but particularly in the severe cases), fat is the first article 
cut down in order to avoid the possible danger of acidosis. 
When, by restrictions in the diet, the urine has become 
sugar-free, the next step is to find the carbohydrate tolerance 
by gradually increasing the daily amount, then the protein 
tolerance or both may be tested together. Last of all fat is 
added. Twenty-four-hour specimens of urine are daily 
examined for sugar, acetone, and diacetic acid. The blood 
is also examined for sugar because an increase in the 
blood-sugar may appear before sugar in the urine. The test 
is always made before breakfast because the blood-sugar 
rises after meals. These examinations determine whether the 
diet may be increased or not. It is one of the nurse’s most 
important duties to see that no errors occur in the collection 
of specimens. 

In building up a diet that the patient can tolerate, in 
addition to the amount of carbohydrate, protein and fat, 


DIABETES MELLITUS 


strict attention is given to the total number of calories. 
If too high it will cause sugar to appear in the urine. On 
the other hand, the body (according to the age and weight) 
even when quietly at rest in bed must have sufficient calories 
to carry on the activities which mean life and prevent 
progressive loss of w'eight. Even when the fat allowed is 
high and excess protein is given sufficient, to supply material 
for building and repair and also for the production of 
energy, the total calories allowed may be pitiably small 
because of the great restriction in carbohydrates. In the 
diet of the normal individual more than half of the energy 
comes from carbohydrates. 

CALORIES REQUIRED DURING TWENTY-FOUR HOURS BY AN ADULT 
WEIGHING ONE HUNDRED AND FIFTY-FOUR POUNDS 


Calories Per Total 

Condition Pound, Body Weight Calories 

At rest. ii to 14 1750 to 2100 

At light work . 16 to 18 2400 to 2800 

At moderate work . 18 to 20 2800103150 

At hard work . 20 to 27 3150 to 4200 


“Children require far more food than adults, because of 
growth and increased activity.” 

THE CARBOHYDRATE, PROTEIN AND FAT IN THE DIET OF A MAN 
DOING MODERATE WORK, WEIGHT ONE HUNDRED AND 
FIFTY-FOUR POUNDS 

Quantity Calories Total 


Food Grains Per Gram Calories 

Carbohydrate . 400 4 1600 

Protein . 100 4 400 

Fat . 100 9 900 


A nurse must therefore not only note the amount of the 
various foods in the diet and the effect upon the patient, 
but also the total calories in the diet, and see that the energy 
provided is conserved for the necessary body activities. 
For instance, when the diet is low calories must not be 
wasted by overexertion or exposure to cold; cold water or 
ice cream (even though made in accordance with the diet 
allowed) should not be given because calories would have 
to be used in warming them. Conservation of energy is 
particularly important in old people. For this reason, fasting 
is usually avoided. 

Fluids .—Diabetic patients are always thirsty. They must 
have water to excrete the sugar, and in acidosis, the acids, in 
the urine. Water, tea, coffee and clear meat broths are 
the usual fluids allowed. Broths must be properly seasoned; 









DIABETES MELLITUS 


salt is good for diabetes. Hot drinks are always best 
because they avoid the loss of calories otherwise needed in 
warming them. (It must be remembered that the large 
amount of urine voided robs the body of heat.) Warm 
fluids are given during the period of fasting. It may be 
necessary to give increased amounts (if the amount of 
urine voided is less than normal) in order to remove acids 
and prevent acidosis. 

Rest and Exercise .—Plenty of sleep and rest are essen¬ 
tial in all cases. Overexertion and fatigue are to be 
avoided; fatigue raises the blood sugar. Exercise in some 
form, however, is always desirable. It keeps the muscles 
in good condition, improves the circulation, metabolism, 
mental attitude and general health. By exercising, the car¬ 
bohydrate tolerance is often increased without sugar appear¬ 
ing in the urine. Out-door exercises and those which are 
enjoyable and diverting give the best results. Exercise should 
be moderate, with periods of rest following. The amount 
allowed depends upon the condition and the total calories 
in the diet. In severe cases overexertion may predispose 
to coma. Massage is valuable. The amount of exercise 
may be increased by training. 

Mental Hygiene. —Quiet, freedom from worry, emotional 
strain, mental excitement, or fatigue are essential. Any 
nervous strain predisposes to coma. “It is dangerous to 
get angry.” Arteriosclerosis is usually present in diabetes, 
particularly in the severe forms and greatly adds to the 
danger of nervous strain. Sleep and mental diversion such 
as reading, writing, games, conversation with friends and 
work which does not cause fatigue are valuable. 

Care of the Skin .—It is extremely important to keep the 
skin in good condition, active, clean, warm, free from irri¬ 
tation, slight wounds, infections, bed-sores, or gangrene. 
It is apt to be dry and harsh due to loss of water in the 
urine. Its function is interfered with, metabolism in the 
tissues is poor and diabetics are very susceptible to in¬ 
fections such as boils and carbuncles, etc. Intolerable itch¬ 
ing and eczema sometimes occur. The urine is irritating 
and may cause pruritus. Emaciation adds to the danger 
of bed-sores. Any break in the skin heals with great diffi¬ 
culty. It must be kept scrupulously clean by daily baths 
and its function stimulated by warmth, exercise, massage and 
by giving plenty of water to drink. Gangrene may be pre¬ 
vented by avoiding conditions which lead to arteriosclerosis, 
and by improving the circulation, especially of the extremi¬ 
ties. 

Care of the Mouth and Teeth is also most important. The 
mouth is usually dry; thirst is distressing. The tongue is 


DIABETES MELUTUS 


dry, red and glazed. The gums may be swollen. Stomatitis 
sometimes occurs. The teeth are often in poor condition, 
which increases the severity of the diabetes. The mouth 
always harbors germs and diabetics are very susceptible to 
infections and frequently die from complications such as 
tuberculosis or pneumonia. The patient should never be 
exposed to infection, but particularly when on a low diet. 
Diabetes always grows worse with infection. A nurse with 
a cold should not take care of a patient with diabetes. 

See Insulin. 

Symptoms to be Watched For and Reported .—Symptoms 

of Coma. —Patients who die of diabetes die in coma. Coma 
may usually be prevented if the early symptoms are noted 
and relieved. It is very difficult to cure. The onset may 
be favored by various factors which are therefore to be 
avoided. These may be an ether anesthesia, impaired func¬ 
tion of the kidneys and failure to eliminate the fatty acids, 
constipation, mental excitement, infections, fatigue, exposure 
and chilling, overeating, fasting, sudden changes in the diet, 
improper regulation of the diet, such as cutting down the 
carbohydrates only, or a sudden increase in the fats with 
a low carbohydrate diet, for without carbohydrates fats 
cannot be burned. 

The Symptoms. — Dyspnea, diabetic air-hunger, in which 
the breaths are deep and straining, is one of the most 
important. It is an effort of the body to get rid of carbon 
dioxide in order to lessen the acidity and keep the reaction 
of the blood normal. Other symptoms are loss of appetite, 
nausea, vomiting, headache, listlessness, drowsiness, weak¬ 
ness, vertigo, ringing in the ears, disturbance of vision, 
excitement or delirium. The blood will show an increased 
percentage of fat. The urine will show the presence of 
/ 3 -oxybutyric acid or diacetic acid or acetone. 

The treatment consists in avoiding the conditions which 
predispose to or deepen the coma. Liquids are given freely 
by mouth, by rectum and sometimes intravenously. A solu¬ 
tion of glucose is sometimes given by rectum to supply fuel 
and prevent the combustion of body fats. When given in 
this way it is slowly a isorbed and oxidized so that the tis¬ 
sues can handle it more easily. Some doctors give a solu¬ 
tion of bicarbonate of soda by rectum or intravenously to 
neutralize the acidity of the blood—other doctors consider 
this harmful. 

Symptoms of Complications, which may occur and from 
which the patient may die, should be recognized immediately. 
The most common complications are pneumonia, tuberculosis, 
nephritis, boils, carbuncles, abscesses, pruritus and gangrene. 

See Insulin. 


DIACETIC ACID 


Urine Tests in Diabetes.—A nurse may be required to 
examine the urine for sugar, acetone, or diacetic acid. 
The following simple tests may be used: 

Tests for sugar. —i. Fehling’s Test. —Put about 3 c.c. 
of urine in a test tube. Add about 5 c.c. of boiling Fehl¬ 
ing’s solution, then boil the mixture and place the tube in 
the rack. The formation of a typical red or golden yellow 
precipitate indicates the presence of sugar. 

2. Benedict’s Test. —Put 5 c.c. of the reagent and eight 
drops of urine in a test tube. Immerse the tube in a water 
bath of boiling water and keep the water boiling. At the 
end of exactly five minutes remove the tube and allow it to 
cool. If the fluid becomes opaque, it indicates that sugar 
is present. If no sugar is present the fluid remains clear 
or only a faint turbidity results due to urates. 

These tests are based upon the fact that sugar is a reduc¬ 
ing agent, that is, it will precipitate or separate heavy metals 
from their compounds. Fehling’s solution, for instance, is 
a compound containing copper, which when precipitated 
gives the usual copper color to the solution. The Benedict 
test is a more sensitive one than Fehling’s because the re¬ 
agent is not reduced by uric acid, creatinin, and other sub¬ 
stances which are in the urine, as Fehling’s solution may be. 

Test for Acetone. —Drop a crystal of sodium nitroprusside 
in 5 to xo c.c. of water. Add 1 to 2 c.c. of this solution and 
a few drops of glacial acetic acid to 5 c.c. of urine and 
stratify strong ammonia over the mixture. A purple ring 
at the junction of the fluids indicates that acetone is 
present. 

Test for Diacetic Acid. —Add a few drops of 10 per cent, 
ferric chloride to about 10 c.c. of urine, drop by drop. If 
a precipitate forms, filter and add a few more drops of 
ferric chloride. A “Burgundy” red indicates that diacetic 
acid is present. If the patient has been taking phenol, 
salicylates, aspirin, acetanilid or antipyrin, a dark color will 
also be produced on the addition of ferric chloride to the 
urine, but it will be a purple rather than a red as when due 
to diacetic acid. 

DIACETIC ACID, TEST TOR 

See Diabetes Mellitus. 

DIACHYLON 

See Lead. 

DIAPHORETICS 

Diaphoretics are drugs used principally to increase the 
secretion of sweat. 

The most common ones are the following: Pilocarpus; 


DICHLORAMINE T 


ipecac (especially in the form of Dover’s powder); anti¬ 
mony; aconite; veratrum viride; spiritus yEtheris nitrosi 
(sweet spirits of niter); muscarine; eupatorium; and many 
of the saline diuretics, such as potassium citrate, solution of 
ammonium acetate, spirit of Mindererus. Most of the 
salicylic acid preparations also increase the perspiration. 

DIARRHEA 

Character. —Acute or chronic, accompanying many patho¬ 
logical conditions, especially in children in whom diarrhea 
in any form must be given immediate attention. 

Causes. —Errors in diet, polluted water or milk, ptomaines, 
bad hygiene, and certain drugs. 

Bowels. —The stools vary in number from three to 
twelve a day. They may be greenish yellow in color, con¬ 
taining mucus and particles of undigested food and, in pro¬ 
longed cases, blood. 

Treatment. —Rest in bed and total abstinence from food 
for from twenty-four to forty-eight hours. Salines are 
usually given by mouth or by rectum, but this is left to the 
discretion of the physician. Very little water is given by 
mouth during the period of total abstinence. Thirst is re¬ 
lieved by bits of ice, and enemas are given if necessary. 

Administration of Diet. —When acute symptoms have dis¬ 
appeared and the stools are becoming more normal in char¬ 
acter and number, a fluid diet of from four to six ounces 
is administered every three or four hours or oftener if pa¬ 
tient is very weak. Brandy may likewise be given in cases 
in which exhaustion is marked. 

Dietetic Treatment. —Concentrated foods of the simplest 
character and only those known to agree. Proprietary infant 
or invalid foods, except malted foods, which exert a laxative 
effect; among those found to be good may be mentioned 
Mellin’s Food, Imperial Granum, and Racahout. 

Foods to Be Avoided. —Fatty foods; pork, veal, and shell¬ 
fish; all foods that are subject to fermentation in the 
stomach or intestinal tract (sugar). 

Foods to Be Limited. —Fluids, soup, beverages, etc., be¬ 
cause they impose more work on the intestines. 

DICHLORAMINE T 

This is an organic chlorine compound prepared by Dakin. 
It does not dissolve very readily in water. In wounds it is 
used in io or 15 per cent, solutions. It is used as a spray 
for the nose and throat and in wounds; usually dissolved 
in chlorcosane, or in chlorinated paraffin, or in chlorinated 
eucalyptol. (See Dakin’s Solution.) 


DIETS 


DIETS, SPECIAL 

There are a number of diets formulated to meet the 
various normal and abnormal conditions. In hospitals these 
are classified as follows, for the convenience of both nurse 
and doctor: 

House Diet.—That which is served to the hospital staff, the 
nurses, and those patients not requiring special diets. 

Liquid or Fluid Diet.—Consisting of milk, nutrient and 
other palatable beverages, broths, and thin gruels. 

Light, Semi-solid or Convalescent Diet.—Composed of 
thick or cream soups, eggs, toast, cereals, custards, jellies 
and ice cream, and later vegetable purees, broiled birds, 
chicken, lamb chops, and rare beefsteak. 

Mixed Diet.'—The diet used in normal conditions and for 
those not affected by any special food. 

Special Diets.—Those designed to be used for certain 
pathological conditions, such as scarlet fever, nephritis, etc. 
These diets are classified as follows: 

Milk Diet.—A diet in which milk is the sole article of 
food. 

Carbohydrate-free Diet.—One in which the sugars and 

starches are eliminated. 

Purin-free Diet.—One in which the foods rich in purin 
bases are eliminated. This is used in gout, arteriosclerosis, 
etc. 

Salt-free Diet.—Diet in which sodium chloride (salt) is 
as far as possible excluded. It is used in certain cases of 
nephritis when edema is present. 

Nephritic Diet.—A diet used in nephritis and diseases 
complicated by nephritis (scarlet fever). In this diet the 
protein foods, meat in particular, are restricted, milk being 
the exception. 

Diabetic Diet.—A diet in which the carbohydrates are re¬ 
stricted or eliminated. 

“Allen Treatment of Diabetes” consists chiefly of “starva¬ 
tion” for a given period and a reeducation of the organs to 
a toleration for carbohydrates. 

Emaciation Diets.—Those containing a high percentage of 
fat-forming foods, such as milk, cream, eggs, cereals, po¬ 
tatoes, etc., olive oil. 

Obesity Diets.—Those containing as few of the fat-forming 
foods as possible, such as cream, olive oil, potatoes, white 
bread, etc., pastry and desserts, candy and soda water, and 
containing lean meats, fish or shellfish cooked and served 
without butter or other fats, fresh or stewed fruit without 
sugar, green vegetables and salads served without oil or 
other fats; one egg a day two or three times a week, coffee 


DIGITALIS 


and tea without sugar or cream, toasted gluten bread (i 
slice) without butter, saccharine substituted for sugar. 

DIGITALIS 

Digitalis is a drug obtained from the leaves of the Digi¬ 
talis purpurea, or Purple foxglove, which grows in most 
temperate climates. The English leaves are the best. 

The leaves of the second year’s growth are mostly used in 
making digitalis preparations, because they contain the 
largest amount of the active principles. 

The active principles of digitalis are the following three 
glucosides: Digitoxin, Digitalin, and Digitalein. 

Digitoxin is the most potent of all, and is largely re¬ 
sponsible for the digitalis effects. 

Local Action: When injected hypodermically, digitalis is 
injurious to the tissues. It often causes inflammation and 
occasionally an abscess. 

On mucous membranes: It causes pain, redness, profuse 
secretion of mucus, and often inflammation. 

Internal Action.—In the mouth: Digitalis has a bitter 
and unpleasant taste. 

In the stomach: Many of the preparations of digitalis 
cause nausea and vomiting. 

In the intestines: Digitalis occasionally causes diarrhea. 

Action after Absorption 

Digitalis preparations are very slowly absorbed into the 
blood from the intestines. It usually takes about 12 to 36 
hours for the effects of the drug to develop. If given hypo¬ 
dermically, it enters the blood sooner, and the effects 
appear more rapidly. 

Since digitalis is so slowly absorbed, it produces pro¬ 
longed effects. It is therefore the best drug to give to a 
patient suffering from chronic weakened heart action (myo¬ 
cardial insufficiency). 

After absorption, digitalis affects principally the heart, 
the medulla of the brain and the kidneys. 

Action on the Heart: Digitalis makes the heart beat 
slower and stronger, consequently the pulse becomes slower 
and stronger. 

Effect on the Circulation.—With each prolonged period 
of rest or diastole the heart fills up with a larger quantity 
of blood. With each succeeding contraction or systole a 
large quantity of blood is pumped into the arteries and is 
kept circulating more freely. The blood itself is of better 
quality because the improved circulation in the lungs 
enables the red blood cells to take up more oxygen. As a 
result of the improved circulation, the various organs and 


DIGITALIS 


tissues of the body are constantly receiving more and 
better blood which improves their nourishment and enables 
them to perform their work better. Stagnation of blood in 
these organs is relieved. Accumulated fluid in the tissues 
(edema) is gradually removed. 

The slow rate at which the improved action of the heart 
and circulation (including the circulation within the heart 
itself) occurs, prevents exhaustion of the heart muscle from 
overactivity. 

Action on the brain: Digitalis affects only the medulla of 
the brain, especially that part of its gray matter which 
sends out impulses to slow the heart. In overdoses, it also 
sends out impulses for vomiting; and in such doses the im¬ 
pulses for motion may be increased so much that convulsions 
may result. 

Action on the kidney: Digitalis increases the flow of 
urine very markedly; especially in cases where the tissues 
contain a great deal of fluid (edema). 

Poisonous Effects 

Since digitalis is slowly absorbed, and excreted still more 
slowly, it does not cause acute poisonous symptoms. 

Cumulative Digitalis Poisoning 

Cumulative digitalis poisoning frequently results from its 
continued administration. Whenever it is necessary to 
administer digitalis for a long time cumulative symptoms 
may be avoided by gradually reducing the frequency of the 
administration or by discontinuing the drug entirely, at 
intervals. 

Symptoms.— i. Persistent nausea and vomiting. 

2. Diarrhea. 

3 . Slow pulse; below 60, which may be irregular. 

This is the most important symptom of digitalis poisoning 
and should always be reported to the physician. It means 
that a condition of heart block has been produced. 

In severe cases, or from an overdose given intravenously, 
in addition to the sudden onset of the foregoing symptoms 
there may be weakness, headache, disturbance of vision and 
dizziness. On the slightest exertion the pulse may become 
very rapid (130 to 150), weak and irregular, the breathing 
becomes slow and deep and the urine may be scanty. 

Treatment.—1. Stop the digitalis as soon as the pulse gets 
below 60 and is irregular. This is usually sufficient in most 
cases. 

2. Keep the patient absolutely quiet. 

3 . Apply an ice bag or a hot water bag to the region oi 
the heart. 


DIGITALIS 


4. Atropine and morphine are the drugs usually given to 
relieve the condition. 

Administration 

For rapid effect, as in collapse, only some of the newer 
unofficial preparations are given. They act more quickly 
than other preparations and can be given hypodermically. 

All preparations of digitalis should be given in a wine- 
glassful of water slightly flavored. They should always be 
given between meals when the stomach contains little acid. 
The presence of large quantities of acid in the stomach les¬ 
sens the absorption of digitalis preparations. 

Digitalis preparations should be fresh and made from 
reliable English leaves. The failure to obtain results from 
digitalis is often due to unreliable preparations. 

Myocardial Insufficiency is the only condition in which 
the nurse may observe striking effects from the use of 
digitalis. In the other conditions only its characteristic 
effect on the pulse may be observed. 

Appearance of the Patient after Digitalis 

When digitalis is given to patients suffering from failing 
compensation or myocardial insufficiency, all the symptoms 
disappear. Within a few days after its administration is 
begun, the patient breathes easier and the blue color of the 
skin disappears. The swelling of the extremities (edema) 
gradually becomes lessened until it completely disappears. 
The pulse is stronger and slower. More urine is passed and 
the nausea and vomiting disappear.. 

Preparations 

Digitalis (Powdered leaves); dose V2 to 2 grains. 

Extract of Digitalis; dose i/fc to % grain. 

Infusion of Digitalis; dose 1 to 4 drams. 

The usual official infusion is a 1.5 per cent, solution, or 
one part of digitalis to 66 2/3 parts of water. 

Many physicians order weaker infusions; such as 1 to 150, 
etc. The dose for such infusions is correspondingly greater. 

Fluidextract of Digitalis; dose 1 to 2 minims. 

Tincture of Digitalis; dose 5 to 15 minims. 

This preparation keeps well and is perhaps the most 
reliable one. 

The following preparations are not official. Many of 
them are used extensively and are very reliable. Some of 
them can be given hypodermically, because they do not 
form abscesses and produce effects rapidly. 

Digalen; dose 10 to 30 minims. 

Digalen is a solution containing digitoxin, the most ac¬ 
tive glucoside of digitalis. The digitoxin in this prepara¬ 
tion has been prepared so that it may be easily dissolved. It 


DILATATION OF STOMACH 


is given hypodermically, and produces its effects in from 
one to two hours. 

It is also given intravenously in doses of 5 to 15 minims 
producing effects in from 15 minutes to a half hour. It can 
be repeated intravenously in these doses about every half 
to one hour. 

Digalen Tablets: Each tablet contains the same amount of 
digitoxin that is contained in 8 minims of digalen. 

Digipuratum: Digipuratum is a preparation of digitalis 

from which many of the inactive substances have been re¬ 
moved. It contains no digitonin, and is therefore not apt 
to cause nausea and vomiting. 

It is made from specially grown leaves, and the dose is 
regulated and accurate. 

Digipuratum Tablets; dose 1 V2 grains. 

These tablets are given in the following way: one tablet 
four times a day, reducing the dose every day by one tablet, 
until ten tablets are taken. The digipuratum is then 
stopped. This allows the body to eliminate the drug which 
it has accumulated. Cumulative symptoms are thus avoided. 

Digipuratum also comes in vials for hypodermic use. 
Each vial contains 1.0 c.c. of fluid, and is equivalent to 
i l / 2 grains of digipuratum. 

Digitoxin; dose ^50 of a grain. 

This is not often used, as it cannot be dissolved easily. 

Digitol; dose 5 to 15 minims. 

DILATATION OF STOMACH 

See Stomach; and Gastric Dilatation. 

DIPHTHERIA 

The cause of diphtheria is the bacillus diphtheria. 

The incubation period of pure diphtheria is short, being 
one to three days as a rule: the prodromal period is still 
shorter, one-half to one day generally, and presents nothing 
diagnostic; the typical symptom is the membrane, but it 
does not always develop in typical form: the fastigium is 
about a week in uncomplicated cases; and recovery from the 
acute symptoms is fairly prompt. Unfortunately, pure 
diphtheria is not often seen, most cases being complicated 
by the presence of a variety of other germs, of which sta¬ 
phylococci and streptococci, probably constitute the most 
usual and important. The natural history of pure diphtheria 
is now difficult of study partly because of the presence of 
other germs, but chiefly because antitoxin is almost uni¬ 
versally used in all cases brought to a physician’s attention. 
The descriptions handed down from pre-antitoxin days make 
diphtheria a horrible disease in which the patient choked to 


DIPHTHERIA 


death from overwhelming masses of membrane, or died 
later from the systemic poisoning. We see the latter now 
at times in neglected cases, but the former is rare, even 
in such cases. 

The complications of diphtheria are peculiarly those ot 
the poisoning effect of the absorbed poison on the nervous 
system, heart and kidneys. 

Paralyses are common, especially slight paralyses affecting 
the soft palate and resulting in regurgitation of liquids 
through the nose when the attempt to drink is made; the 
voice, of course, is affected also. These paralyses may 
affect the limbs. Loss of knee-jerks is common. The most 
serious result is heart failure, which often terminates fatally 
cases which appear to be in other respects on the high 
road to recovery. 

The treatment of diphtheria is, unlike the treatment of 
most of these infections, specific. We know the poison 
(diphtheria toxin); we know the substance (diphtheria anti¬ 
toxin) capable of neutralizing it in the body. The patients 
who recover without artificial aid do so because they manu¬ 
facture this antitoxin themselves in sufficient quantity to 
prevent the poison overwhelming them. The secondhand 
antitoxin, manufactured in the horse in advance and ready 
for artificial administration to the patient, accomplishes the 
same end, but can be given in enormous doses promptly, 
instead of awaiting its development at the mercy of the 
toxin versus the patient’s own antitoxin-making power. 

Early treatment with sufficient doses of antitoxin is the 
secret of success. Not less than 10,000 units should be given 
at the first dose, 20,000 if the patient is seen after the 
second day, 30,000 or more if seen first after the third day. 
These doses should be repeated in each case within eight 
hours unless marked improvement has occurred. In early 
cases intramuscular injection is indicated—into the buttocks 
or outer aspect of the thigh about its middle. In late or 
severe cases, intravenous injection is called for, because the 
intramuscularly-placed serum is absorbed more slowly. Sub¬ 
cutaneous injections should not be used, at any stage, for 
absorption is too slow, and the pain of inoculation is greater 
than in either of the other methods—an important item in 
children, especially since it is usually necessary to give an¬ 
other dose later. The immunity conferred by antitoxin is 
not lasting-^two weeks at the most. Toxin-antitoxin mix¬ 
tures give more permanent results. 

In about ten per cent, of patients a rash will develop as 
the result of the injection, usually about a week later, and 
is often startling to those not familiar with serum treatment. 
It is due to the fact that horse serum has been used, not to 


DIPHTHERIA ANTITOXIN 

the antitoxin proper—normal horse serum will produce the 
same effect. 

Anaphylactic shock may occur and is discussed elsewhere. 
Asthmatics and persons showing horse-sensitiveness, should 
not receive antitoxin unless in extreme necessity. It should 
be administered in such cases thus—one drop only should 
be injected; wait an hour; if no evil effects have occurred, 
give the rest; if they have occurred and the patient has 
survived, give the rest. 

The heart of a diphtheria patient should be treated with 
the greatest consideration, whether the disease be mild or 
severe, whether the antitoxin treatment has been followed 
well or ill, whether the case is first seen early or late. This 
means, rest in bed, with an absolutely effortless regime for 
the patient, to last at least two weeks, better three, after 
the membrane is gone. Such patients should receive a stand¬ 
ardized digitalis preparation from the moment the acute 
symptoms moderated, in order to provide such additional 
rest for the heart as may be thus possible. 

See Infectious Diseases, Course of; Pharynx. 

DIPHTHERIA ANTITOXIN 

See Serums. 

DISINFECTION AND STERILIZATION 

Sepsis means poison produced by putrefactive bacteria. 

A septic wound is an infected wound. 

Asepsis means freedom from infection. 

Sterile means free from germs. 

An aseptic wound or dressing is one free from germs, 
or sterile. 

An antiseptic is an agen.t by whose means the growth 
of germs is prevented (but it does not kill them). In a 
wound antiseptics prevent putrefaction by virtue of their 
action in arresting the growth of organisms or the chemi¬ 
cal activity of certain substances which give rise to fer¬ 
mentation and decomposition. They include carbolic acid, 
boracic acid, iodine, alcohol, balsam of Peru, and many 
others. 

A disinfectant is an agent which kills germs. In a 
wound disinfectants destroy germs or active chemical sub¬ 
stances on the surface already infected or foul. They are 
for the most part the same material as the antiseptics but 
are used in a much stronger form, as strong solution of 
carbolic acid, iodine, etc. 

Deodorant is an agent used to destroy odor. The best 
deodorant is fresh air. Chemical deodorants absorb gases 


DISINFECTION 


and neutralize foul odors. Those chiefly used are char¬ 
coal, permanganate of potassium, etc. 

Sterilization 

The important point in modern methods of treating a 
wound is to have preparations made beforehand in order 
that all things used in such treatment may be perfectly 
free from germs, or as it is called, sterile. 

Sterilization is a method of destroying germs with heat 
by such methods as: 


Boiling temperature .212° 

Steam pressure temperature .230° 

Dry heat .300° 


In hospitals and large sterilizing plants the heat is ar¬ 
ranged in large sterilizers and the dressings, instruments, 
or any articles to be rendered sterile, are left in the ster¬ 
ilizer at a definite heat for the required length of time. 

General disinfecting of utensils, instruments, dressings 
for wounds (cotton, gauze), fluids or lubricants, and clothes, 
is usually done by the process of sterilization, but chemicals 
are also used for this purpose. The latter, however, are 
used chiefly in strong solution for disinfeoting the direct dis* 
charges that contain germs, or at a weaker strength as 
antiseptics. But their use and strength should be governed 
by the physician in charge. 

Any sterile solutions of the strength required, dressings, 
gauze, cotton, instruments or utensils, are obtainable in 
sterile, sealed packages at a local drug store. 

Practical suggestions for sterilization. In households 
where there are not likely to be any definite arrangements 
for such a purpose, sterilization may be most practically 
accomplished by first cleansing the article and then boiling 
it for the required time and using it undried when taken 
out of the water, unless there is a sterile substance to 
dry it on. 

To make sterilization consistent and of any use, do not 
touch the sterilized article vith the fingers, if possible to 
use a sterile instrument, such as forceps, or sterile scissors; 
and in any case, the part to come in direct contact with the 
body must not be made unsterile by careless handling. 

To sterilize a dressing. To sterilize a dressing, place 
the gauze, cotton, linen or old muslin, folded in a conven¬ 
ient size, in an outside cloth and pin or tie together, and 
then boil for twenty minutes. Wring partially dry (while 
still in the outside cloth), then apply the inside dressing 
moist, taking care not to touch your own fingers to that 
part of the dressing which is to be applied to the wound. 





DISINFECTION 


To sterilize towels. To sterilize towels, wrap several 
together in an outside cloth and boil twenty minutes; wring 
out as described above and use the inside towels while they 
are wet. 

To sterilize rubber. Gloves, bags, tubings, or any rubber 
utensil, may be boiled from two to five minutes. These 
may be wrapped in a cloth and removed from the water 
without touching, or they may be boiled directly in the 
water and removed with sterile forceps, without touching 
that part which will come in contact with the patient. Never 
use soda when boiling rubber as it softens it too much. 

To sterilize instruments. Needles, scissors, forceps, nail 
files, etc., are sterilized by placing them in boiling water in 
which i per cent, of soda has been dissolved (this is to 
prevent rusting), and boil for five minutes. 

For glass utensils, tips, nozzles, etc., place them in cold 
water, bring to a boil, and boil five minutes. 

For larger utensils, place them in a large sauce pan or 
washing boiler and boil for ten minutes (active boiling). 

To sterilize gauze or cotton. To sterilize gauze or cotton 
or the stoppers of babies’ bottles, place them in a bottle 
with an airtight cover, surrounding this with cold water, 
(do not let the bottle come in direct contact with the bot¬ 
tom of the pan), and bring the water to a boil. Keep it 
boiling for an hour. 

Fluids, oils, or tubes of vaseline can be treated in the 
same way and thus made sterile. Water can be sterilized 
by straining or filtering it and then boiling it, taking care 
that it is kept in a sterile receptacle. 

Methods of Disinfecting 

Disinfecting. Generally speaking, sterilization means the 
process of destroying germs by heat, while disinfecting 
usually implies the use of chemical agents. This latter 
method is especially used to destroy germs in direct dis¬ 
charges from the body. These chemicals are strong poisons 
and should only be used by the direct orders of the phy¬ 
sician. 

Stools, or movements from the intestines. Use the partic¬ 
ular disinfectant in the strength ordered by the physician. 
Place as much of this as there is fecal matter in the 
vessel, stirring it thoroughly with an implement that can 
be boiled or destroyed (for instance a glass stick which 
can be easily boiled). Over this vessel place a cloth wrung 
out of the disinfectant and leave it from one to two hours. 
Then the stools can be safely disposed of in the usual 
way and the vessel rinsed and thoroughly washed with soap 
and water. 


DISINFECTION 


Urine. Place equal parts of urine and disinfectant to¬ 
gether, leave for half an hour, and then dispose of in the 
usual way. 

Vomited matter may be treated in this same manner. 

Sputum should be disinfected when it contains germs from 
a diseased condition local to lungs, nose or throat. If 
it is possible have the patient use paper sputum cups and 
burn these intact. But if this is not practical, have the 
patient expectorate into a cup in which there is a little 
water (to prevent sputum drying and allowing the germs 
to escape into the air). At intervals of at least every six 
hours, mix the sputum that has collected in the cup with 
the ordered disinfectant. Leave it for an hour, covered, 
and then dispose of it in the usual way. If cloths are 
necessary to catch the sputum, substitute if possible paper 
napkins, or use old cloths which can be burned; otherwise 
these must be disinfected like any other receptacle, or 
boiled at once, as they contain the direct discharge. 

Clothes should be boiled as this destroys the germs. They 
are usually kept in a weak solution of chemicals until a 
convenient time to boil them. The weak solution of 
chemicals only prevents the growth of the germs tem¬ 
porarily, while boiling directly kills them. If there is 
any discharge on the clothes they should be boiled at 
once. 

Dishes. The simplest and surest way is to boil them for 
ten minutes. If this is not feasible, they may be left in 
the ordered solution of chemical disinfectant for half an 
hour and then washed with soap and water as usual. 
Those dishes coming in direct contact with the mouth, such 
as cup, glass, spoon, fork, etc., should be boiled. 

Hands. Scrub the nails, hand and forearm thoroughly 
with a brush, soap and water for five minutes, then hold 
the hands in a chemical disinfectant as ordered for another 
five minutes. If no disinfectant is to be used after the 
washing, alcohol (from 50 per cent, to 70 per cent.) may 
be thoroughly rubbed into the hands. Dry the hands on 
a sterile towel, or shake them dry. 

Chemical solutions. The chemical solutions most com¬ 
monly used for direct application to the body are: 

Salt, or saline solution, made by adding 1^/2 teaspoonfuls 
or 90 grains of salt in 1 quart of water and boiling. This 
is chiefly used for washing out wounds, cavities, for all 
sorts of irrigations and douches, and is not irritating to the 
surface when applied in this strength; and 

Boracic acid solution, made by adding 1 part of boric 
acid powder to 24 parts of boiled water, which equals a 
solution of 4 per cent. This is used in strength varying 


DISINFECTION 


from 2 per cent, to 5 per cent. It is particularly non¬ 
irritating and is used for eyes, nasal sprays, irrigation for 
wounds, cavities, etc. 

These two solutions while largely used on the body sur¬ 
face or in cavities are not strong enough to be effective as 
external disinfectants. 

Alcohol, 95 per cent., or weaker (50 per cent, to 70 per 
cent.) may be used for external disinfecting of the skin or 
for disinfecting instruments or thermometers. 

Milk of lime solution (1 part of slaked lime to 4 parts 
of water) is used for disinfecting discharges. Other chem¬ 
icals sometimes ordered by a physician are: 

Carbolic acid solution (2 per cent, to 5 per cent, strength) 
—6 drams or teaspoonfuls to 1 pint of water makes a 5 per 
cent, solution. 

Bichloride of mercury—1/1000 to 1/5000 strength—7^2 
grains of bichloride of mercury to 1 pint of water makes 
the strength of 1/1000. 

Formalin solution—4 per cent, to 10 per cent, strength. 
This comes in a 40 per cent, solution, 1 part of formalin 
to 9 parts of water makes the strength of 4 per cent. 

Disinfecting a Room 

In case it is necessary to disinfect a room after an ill¬ 
ness of an infectious nature, it is fumigated and the in¬ 
fection destroyed by the gases of the chemicals used. This 
process is also used for cleansing rooms from insects, ver¬ 
min, etc. 

Preparation of room. Gather such things as books, toys, 
etc., that have been used by the patient, and if there is 
a stove or grate in the room burn them. Otherwise, have 
them taken to a furnace and destroyed after they have been 
fumigated with the rest of the room. 

Open bureau drawers and closets and hang up pillows 
and blankets on a line and spread the mattress so that the 
air gets underneath it. Close windows and ventilators and 
cover fireplace. Close up all crevices around doors, etc., 
by strips of paper pasted over the openings (use simple 
flour paste which can be easily wiped off). 

Method. Have water in a large dish pan or tray near 
the floor with a protector under it. Formalin candles are 
generally used for this purpose, placing three or four 
(for an average sized room) in this dish of water, sup¬ 
ported on the tin stands that come with them. As there 
is no wick in them, hold a taper or candle to the edge until 
the ash begins to get white and fall away. This liberates 
the gas into the room and disinfects it. Moisture in room 
makes it more effective. 


DISLOCATIONS 


If sulphur is used, make the same arrangements, and 
place 4 or 5 lbs. of rock sulphur (for an average sized 
room) in a sauce pan, saturate with alcohol, and when 
this pan is placed in a larger one light the alcohol to start 
the sulphur burning. The door should be closed and se¬ 
curely sealed from the outside. Leave the room for twelve 
to twenty-four hours, then open the windows and thor¬ 
oughly air and clean the room. Sulphur fumigating is 
frequently used for destroying vermin. Sulphur will de¬ 
stroy roaches but not ants. 

When entering a room after it has been fumigated, to 
open the windows, hold a damp cloth to the mouth and 
nose to prevent the irritating effect of the gas on these 
parts. 

DISLOCATIONS 

A dislocation is the separation of the articular surfaces 
of two or more bones entering into the formation of a joint. 

Symptoms. —There is first sickening or nauseating pain, 
greatly increased by motion of the part which causes pres¬ 
sure of the dislocated bone on nerves, etc. Deformity with 
a lengthening or shortening of the limb occurs depending 
upon the line of displacement. There is limited motion or 
loss of function in the part. After the reduction there is 
no tendency to a redisplacement as in a fracture. There 
may be swelling of the surrounding tissues. Some degree 
of shock is nearly always present. 

Complications. —Injury to blood vessels, nerves and soft 
tissues, or contusions may occur. One or more bones may 
be fractured. The dislocation may be compound, that is, 
an external wound leads to the injured joint. A severe hem¬ 
orrhage resulting in a hematoma sometimes occurs. 

Treatment. —First Aid .—The limb should be put at rest in 
the position most comfortable for the patient. For a dislo¬ 
cation of the joints of the upper extremity—shoulder, elbow, 
or wrist—apply a splint or a bandage and support the arm 
in a sling. For a dislocation of the hip, knee, or ankle, the 
patient should be put to bed and a splint applied. To 
lessen the pain and swelling, ice compresses or the well- 
known lead and opium solution may be applied. Treat for 
shock if present. 

The reduction of a dislocation requires both considerable 
knowledge and skill, and should never be attempted by an 
inexperienced person if it is at all possible to obtain the 
services of a surgeon, even after the lapse of many hours. 
Permanent injury may be done by improper manipulation. 
Frequently a general anesthetic is necessary to relax the 
muscles and relieve pain before reduction is possible. 


DIURETICS 


DIURETICS 

Diuretics are drugs which increase the flow of urine. 
They may be divided into 

1. Cell Stimulating Diuretics 

2. Irritant Diuretics 

3. Circulatory Diuretics 

4. Saline Diuretics 

Cell Stimulating Diuretics are drugs which increase the 
flow of urine by directly making the cells of the kidney se¬ 
crete more urine from the blood, without injuring the cells 
themselves. The chief ones are: Caffeine and Theobroma. 

Irritant Diuretics are drugs which increase the secretion 
of urine by irritating (injuring) the cells of the kidney and 
therefore making them secrete more urine from the blood. 
In large doses these substances may cause inflammation 
of the kidney. The chief ones are: Scoparius, Juniper, 
Uva Ursi, Chimapliila, Zea, Triticum, and Calomel. 

Circulatory Diuretics are drugs which increase the secre¬ 
tion of urine by improving the circulation of the kidneys 
so that more fresh blood is constantly being brought to 
them from which to form urine. This effect may result from 
the action of a drug on the heart, as from digitalis. It 
may also result from widening (dilating) the blood vessels 
of the kidneys so that the blood flows more freely through 
them and more urine is therefore able to be formed. The 
nitrites increase the secretion of urine in this manner. The 
chief ones are: Digitalis, Strophanthus, Squill, Apocynum, 
Nitrites, Pituitary Extract, and Nitrates. 

Saline Diuretics increase the secretion of urine in the 
following manner: Only the salts which are absorbed are 
able to increase the secretion of urine. When these salts 
enter the blood they increase its percentage of salt and 
the osmotic power of the blood is thus increased. As a re¬ 
sult, fluid is withdrawn from the tissues into the blood un¬ 
til the blood becomes filled with an excess of fluid. This 
excessive flyid then passes from the small blood vessels' of 
the kidneys into the tubules, at the glomeruli (where blood 
vessels and tubule9 meet), thus increasing the secretion of 
urine. The chief ones are: Potassium acetate, Potassium 
bitartrate, Potassium citrate, Sodium acetate and salts of 
Lithium and Strontium. 

Several of the urinary antiseptics also act as diuretics: 
Urotropin, Methylene Blue, Buchu, Oil of Erigeron, Oil 
of Santal, Copaiba, Cubebs, Matico. 

DIURETIN 

See Theobromine. 


DOSAGE 


DOBELL’S SOLUTION 

See Boric Acid. 

DONOVAN’S SOLUTION 

See Arsenic. 

DOEMIOL 

Dormiol or amylene chloral, is a colorless, oily fluid with 
an odor like that of camphor. It is a compound of amylene 
hydrate and chloral. It produces sleep in about half an 
hour after it is given, with no after-effects and it does not 
weaken the heart action. It is given principally to insane 
patients. Dose, 15 to 60 minims. 

DOSAGE 
Buie for Dosage 

There is no rule whereby the doses of all drugs may be 
remembered. The dose of each drug must be memorized. 
The following rule, however, will facilitate the remembering 
of the principal preparations of the common potent drugs 
such as opium, nux vomica, belladonna, digitalis, etc. 

The dose of the crude drug is 1 grain or 0.065 gm. 

Fluidextracts represent 100 per cent, of drug, therefore 
the dose is the same as the crude drug, but in fluid measure: 
1 minim or 0.065 gm. 

Tinctures are 10 per cent, solutions; they are l/io as strong 
as the drug, therefore the dose is 10 times that of the 
crude drug but in fluid measure; of the potent drugs it is 
usually 10 minims or 0.6 c.c. 

Extracts are concentrated solid preparations which are 
about 4 times as strong as the crude drug; therefore the dose 
is 14 as much as the crude drug; of the potent drugs it is 
usually !/4 of a grain or 0.015 gm. 

Conditions Influencing the Dose 

Age: An older person usually requires a larger dose than 
a younger one. Old people and children, however, require 
smaller doses. 

Young’s rule for dosage is represented by the formula 

x 

-, in which x = age of the child. Thus a child of 

x + 12 

x 441 

4 years of age will require -=-= — = — of 

x + 12 4 + 12 16 4 

an adult dose. 

Sex: Males usually require larger doses than females. 

Weight: Heavier, stouter individuals usually require 

larger doses than lighter ones. 




DOUCHES 


Temporary conditions: After a meal more absorption 
usually takes place, therefore the effects are usually more 
marked. 

Time of Administration: Some substances produce better 
effects at different times. Thus drugs which produce sleep 
cause little effect in the morning and a better effect at 
night. 

Pregnancy: In pregnancy potent remedies should be given 
in the smallest quantities, since they are apt to cause abortion. 

Lactation: In the nursing woman care must be exercised 
in the doses of many remedies which are eliminated in the 
milk and which may therefore induce poisonous symptoms 
in the nursing child. 

DOUCHES 

A douche consists of a single or multiple column of water 
directed against some portion of the body. 

Physiological effects .—By the application of the douche 
all the thermal effects due to applications of either heat or 
cold are hastened and intensified by the mechanical effects 
of the pressure or force and volume of water used. 

The effects depend upon the following factors: 

1. The temperature of the water used. This varies from 
45° to 125 0 F. 

2. The pressure, which varies from ten to sixty pounds. 

3. The duration varies from three or four seconds to four 
or five minutes, depending upon the temperature, pressure 
and other factors in the application. 

The neutral or sedative douche at a temperature of 92 0 
F. and with very low pressure is sometimes prolonged to 
fifteen minutes. 

4. The form of the stream is determined by the outlet. 
The horizontal, vertical, fan, or broken jets may be used. 
The form may be the shower, spray or needle bath applied 
to the surface of the body and irrigations to various cavities 
of the body such as the eye, ear, nose, throat, stomach, rec¬ 
tum, colon, bladder, vagina or uterus. 

5- The area covered, which may be local or general. 

6. The part of the body to receive the application, if local, 
as in the dorsal, lumbar and spinal douches. 

Purposes of the douche: 

The douche, either as a local or general application, may 
be used to produce tonic, stimulating, sedative or analgesic 
effects as desired. 

It is contraindicated in acute inflammation, and in very 
nervous excitable patients where it is necessary to suppress 
reaction due to the application. 

As the effects of the douche depend entirely upon the 


DOUCHES 


scientific regulation of the above-mentioned factors and as 
these factors can only be accurately administered by a 
highly trained person and by specially constructed apparatus, 
no attempt will be made here to discuss the various applica¬ 
tions. A spinal douche, however, may be given fairly suc¬ 
cessfully either in the hospital or in a private home, and 
so may be prescribed by the doctor. 

Spinal Douche 

In the spinal douche a stream of water is moved rapidly 
up and down over an area covering the whole surface of 
the spine and extending three or four inches on either side 
of it. 

The effects of the treatment vary according to the tempera¬ 
ture, pressure and duration of the application: When 

special apparatus is not available it is difficult to obtain the 
exact temperature desired and impossible to secure the 
desired pressure. When desirable, friction may be used as 
a mechanical substitute for pressure. 

A tonic effect may be obtained by a cold spinal douche. 
The temperature may vary from 45 0 to 78° or 8o° F. The 
duration may be for three or four seconds. 

A sedative effect may be obtained by a tepid (80 to 92 0 
F.) or a neutral (92 0 to 97 0 F.) douche. The duration may 
be three or four minutes. 

An analgesic effect may be obtained by a hot douche. 
The temperature varies from 104° to 125 0 F. The duration 
may be from one-half to four or five minutes. 

The temperature should begin at ioo° F. and gradually in¬ 
crease to the maximum. As a hot douche is usually given 
to relieve pain, a low pressure is always used and the 
stream must be rapidly moved from point to point to pre¬ 
vent burning. The high temperature mentioned may be 
used because the skin of the back is not as sensitive as in 
other parts of the body. 

The Scotch Douche. —The spinal douche may be given in 
the form of a Scotch douche in which a single application 
of hot water is followed immediately by a single application 
of cold water. The hot douche lasts from one to four 
minutes, and the cold douche from three to thirty seconds. 

The purpose of the hot douche is to warm the part in 
order to intensify the effect of the cold, and to secure a 
better reaction. It also trains the patient to react to the 
cold douche and makes it feel grateful. The cold douche 
must follow the hot instantly as any lapse allows the wet 
surface to cool off rapidly by evaporation. The purpose of 
the hot application would then be lost. 

The Alternate Douche. —When the spinal douche is given 


DOUCHES 


in this form, hot and cold applications are repeatedly applied 
in alternation. The duration of each application is usually 
about fifteen seconds. 

Method of Procedure. —When the treatment is given to the 
patient in bed, the preparation of the patient and bed is 
the same as in a spray or slush bath. The patient should 
lie prone or on his side. Only the back should be exposed. 
A hot-water bottle may be placed at the feet, if necessary, 
as they must be warm. The body should also be warm. 
Friction may be applied before, during and after the treat¬ 
ment, if necessary, to obtain the reaction. Cold applica¬ 
tions may be applied to the head. 

When the patient is able to get out of bed, he is covered 
with a large sheet or bath blanket and is allowed to sit 
on a board placed across the foot of a bath tub. He may 
sit on a box or stool placed in the tub. This is especially 
advisable to avoid an accident and injury when the treat¬ 
ment is given for chorea in which the jerky, uncertain and 
uncontrollable movements of the patient make it impossible 
for him to sit without support. His back should be toward 
the faucets. The sheet or blanket is then draped so as to 
completely cover the body, leaving only the back exposed. 
The feet should rest on a stool or should be placed in 
a foot-tub of water at from ioo to no° F. In a very hot 
douche this is necessary to prevent burning and in a cold 
douche to secure reaction. 

To give the douche a spray is attached to the faucet and 
the stream is moved rapidly up and down over the prescribed 
area. When a hot douche is used great care must be taken 
to avoid burning the patient. A nurse should test the 
temperature of the water by directing it against her arm. 

When the treatment is completed the care of the patient 
is the same as after a sponge or spray bath. 

Vaginal Douche 

Solutions used as douches are given for their antiseptic 
or constricting (astringent) effect on the mucous membrane 
of the vagina and cervix, and to remove accumulated secre¬ 
tions. Douches are also given to check bleeding from the 
uterus or cervix, and to lessen pain produced by their 
contraction. Contact with the diseased tissues is essential 
for the effect. It is especially important that every part 
of the vaginal fornix be irrigated to remove the secretions 
which usually accumulate in these regions. 

Por an antiseptic or an astringent effect, or for drainage, 
the temperature of the fluid should be that of the body, 
about ioo° F. To check bleeding or to lessen pain, solutions 
should be as hot as the patient can stand. 



DOVER’S POWDER 


Articles Required 

1. Sheet or bath blanket. 

2. Warmed douche pan and cover. 

3. Irrigation stand. 

4. Douche tray, provided with: 

(a.) Douche can and tubing with stopcock or clamp 
(sterilized). 

( b ) Glass douche nozzle (sterilized). 

(c) Bath thermometer (sterilized in carbolic or lysol solu¬ 
tion, 10 per cent.—1-10). 

id) Jar of cotton pledgets or gauze. 

( e ) Paper bag. 

( f ) Bath towel or dressing towel. 

(g) Bath blanket. 

(h) Solution required—2 quarts or amount as ordered, 
temperature 105° to no° F., or as ordered, solution to be 
in sterile pitcher or glass graduate. 

Procedure 

Patient on back, knees flexed, head on one pillow. Turn 
down upper bed clothes to foot of bed, but covering 
feet, cover patient with sheet or bath blanket as necessary 
for warmth, length crosswise of bed, draw up nightgown 
well above hips, place folded bath towel under buttocks. 
Make a reverse fold or twist of sheet or blanket as in 
giving an enema, see that chest and legs are well covered. 
Place folded dressing towel on shelf of pan, adjust under 
patient so that she will be comfortable and not strained; if 
necessary a small pillow or folded towel may be placed 
under back above douche pan. Pour solution into can and 
hang on irrigator stand at height so that lower part will be 
about 20 inches above bed. Return to dressing room, scrub 
hands thoroughly in hot running water, using plenty of 
soap, rinse well, do not dry except on sterile towel. Return 
to bedside. Adjust sterile nozzle to tube, examine for 
cracks, allow solution to run through into douche pan until 
tube is warm and air expelled. Douche vulva well, sepa¬ 
rate labia, douche vaginal outlet, being careful not to allow 
nozzle to touch labia. Insert nozzle in vagina in a down¬ 
ward and backward direction and while fluid is running 
turn nozzle gently round and round in order that every 
part of the cavity may be cleansed, hold tube while fluid 
is running. Remove tube before solution is completely ex¬ 
hausted, leave patient on pan for a few minutes, dry well 
around vulva with cotton or gauze, remove pan, dry back, 
bring up bed clothes, arrange pillows. 

DOVER’S POWDER 

See Ipecac; and Opium. 


DRAINS 


DRAINS 

Cigarette Drain.—For this a piece of rubber dam or rub¬ 
ber tissue of suitable size will be used, and within it will be 
rolled, lengthwise, cigarette fashion, a piece of gauze of a 
size to fit the wound, the ends of the gauze being allowed 
to project slightly beyond the rubber (A of Fig.). 



Mikulicz Drain. —A square piece of gauze or rubber dam 
large enough to line the entire wound is folded as indicated 
in B 1 of Fig.—that is, diagonally several times. With a 
pair of sharp, curved scissors small notches are cut in this 
folded piece of material as shown in B 2 of the illustration. 















DRAINS 


For insertion the drain will be unfolded, and after it has 
been perforated it should appear as shown in B 3 of the 
illustration. \\ hen this is in place in the wound it will be 
packed full of gauze packing. 

Rubber Tissue and Rubber Dam. —Pieces of either of 
these materials may be folded flat or rolled into tubes of 
suitable size (C of Fig.). 

Rubber Tubing. —Pieces of rubber tubing may be fash- 







<u 

2-a 

•*-* r-J -» 

1-. U 
<L> Q 
>, .O 
.a i- 

° £ 

« ° o' 

*C0 O 

v a ° 

•TJ-- -O 
rt •** 
<fl i- H 
3T) .'x 
•2+> 

> v. 


SS^ 

Q 



ioned in various ways (D of Fig.). The gauze packing 
may or may not be used in these drains. The large drain 
of group D has the rubber tube inside of the gauze, and 
the whole is encased within a few layers of rubber dam. 

Horsehair and Silhwormgut. —A strand may be rolled 
into a suitable shape for small wounds. (E of Fig.). 

























DRASTICS 


Rubber Bands. —For small drains an ordinary rubber band, 
either whole or in part, may be used. (F of Fig.). 

Gauze Packing. —This will need no special preparation. 

A safety pin should accompany every drain, either to pin 
it fast to the dressing or to serve as a guard against its 
slipping into the wound and becoming lost. 

A pair of dressing forceps is, of course, always among the 
general instruments, and this should always be in readiness 
for the insertion of the drain. 

DRASTICS 

See Cathartics. 

DUNBAR’S SERUM 

See Pollantin. 

DYSENTERY 
Entamebic Dysentery 

This is a wide-spread disease of infectious origin char¬ 
acterized by frequent evacuations containing mucus and 
blood and accompanied by abdominal pain, tenesmus, and 
general bodily depression. 

Cause: Predisposing: Anything which will lower bodily 
resistance, mainly unsanitary conditions and dietary indis¬ 
cretions. 

Exciting: The Entamoeba Histolytica, a protozoal organism 
which invades the large intestine causing extensive ulcera¬ 
tion. The organism is taken into the system through con¬ 
taminated food and drink. All grades of severity are ob¬ 
served, ranging from the mildest degree of bowel derange¬ 
ment to the severest attack of dysentery, dependent on the 
location, the extent of the lesion, and the reaction of the 
patient to the infection. The disease is either acute or 
chronic. 

Symptoms of Acute: The attack is ushered in by diffuse 
abdominal cramps and diarrhea of a watery nature. The 
character soon changes and the stools consist mainly of 
mucus and blood. Tenesmus is a marked feature. Severe 
toxemia shown by fever, rapid pulse and severe prostration 
often develops at an early stage. The temperature at the be¬ 
ginning is rarely high, but reaches 103° to 105° F. during 
the later stages. The abdominal wall is retracted and rigid, 
being sensitive to the touch especially in the right and left 
lower quadrant. In fatal cases, symptoms become pro¬ 
gressively worse, resulting in death within a week. In cases 
which show a favorable outcome, a tendency to improve¬ 
ment becomes evident by the fourth or fifth day. The stools 
become less, but their dysenteric character may remain for 


DYSENTERY 


weeks. After recovery from an attack the encysted form 
of the organism often persists in the stool and the patient 
becomes a convalescent carrier of the infection and may 
or may not succumb to further attacks. 

Symptoms of Chronic: This is by far the most common 
form. It is characterized by acute and subacute attacks 
with intervening periods of comparatively good health. 
Though not definitely ill, an impairment of bodily vigor is 
noticeable; there is depression, and the patient is easily 
fatigued; digestive disturbances and progressive loss of 
weight and loss of appetite are noticed. There may be 
nausea and vomiting and constipation; a moderate degree of 
anemia is present together with abdominal pain and sore¬ 
ness resembling appendicitis. There is a close relationship 
between ametic dysentery and abscess of the liver. 

Treatment: Prophylactic: i. Disinfection and sanitary 
disposal of feces. 

2. Safeguarding of water supply. 

3. Boiling all drinking water and milk when possibility 
of infection is present. 

4. Avoiding raw fruit and raw vegetables grown in infected 

soil. 

5. Destruction of flies and their breeding places. 

Curative: The patient should be put to bed and not 

allowed to visit the toilet. No solid food should be given. 
Diet should consist of broths, strained soup, tea, whey, and 
albumin water. Milk is contraindicated during the early 
stages. Food should be given neither very hot nor very cold 
and in small quantities. 

Hot, moist compresses to the abdomen will, to some extent, 
control the pain; if pain and tenesmus are severe, some 
opiate must be given. Morphine is best, and should be given 
in small doses 04 grain) and hyperdermically. For vomiting 
ice cloths to the back of the neck have been found efficacious. 
After stool, the patient should be bathed and the skin pro¬ 
tected from irritation by vaselin or a dusting powder. The 
medical treatment consists of giving emetine hydrochloride 
1 to 1V2 grains, subcutaneously, or half a grain intravenously 
once a day; a larger dose is not safe as emetine is a de¬ 
pressant. 

In chronic dysentery, ipecac root 5 grains in form of 
salol-coated pills is administered. The nurse should inspect 
the stools as these pills are often passed without being dis¬ 
solved. This can be remedied by piercing the salol coating 
with a surgical needle. When ipecac is given, it is best to 
give it just before retiring, and the patient is urged to go 
right to sleep. No food should be taken for several hours 
before administration. 


DYSENTERY 


Bismuth Subnitrate, Magnesium Sulphate, and Chenopo- 
dium are also used. Irrigations of Quinine Sulphate, Silver 
Nitrate, and Potassium Permanganate solutions are useful but 
should not be used during ipecac treatment. The stools 
passed after a saline cathartic are best suited for micro¬ 
scopic examination for amebse. 

Bacillary Dysentery 

This is an infectious disease of the intestinal tract, caused 
by one of the bacilli of the dysentery group, characterized 
by frequent stools containing blood and mucus and accom¬ 
panied by pain and prostration. It occurs in all climates 
but is more common in the tropics. As with other enteric 
diseases, the infecting agent enters the mouth with con¬ 
taminated food or drink. It passes into the stomach and 
small intestines where it begins to multiply. As the or¬ 
ganisms increase in number, toxins are produced which are 
absorbed into the circulation. These toxins give rise to the 
dysenteric symptoms and the prostration. 

Symptoms: The disease usually begins suddenly, often 

with rigors, headache, and vomiting. From the beginning 
there is great prostration. The temperature is slightly 
elevated, though it may go to 103° or 104° F. The pulse is 
rapid and small; the tongue is heavily coated and, as the 
disease progresses, shows the imprint of the teeth. 

The characteristic symptoms are the frequent bloody stools 
and abdominal pain. The number of stools may reach 
30 to 40 in twenty-four hours. The movements are small 
and consist exclusively of blood and mucus with not a 
trace of fecal matter. A single stool is often not more 
than a teaspoonful, and yet the patient complains of inces¬ 
sant desire to go to stool; the evacuations are extremely 
offensive. Vesical tenesmus is also frequently present, and 
the urine is scanty and high-colored. The patient complains 
bitterly of thirst; jaundice may appear. In severe cases 
death occurs in a few days; cases which recover, usually do 
so in 8 or 10 days; but the disease may become chronic 
and last for months or years. 

In infants the character of the stool varies; blood is usually 
present either in small specks or streaks on the surface of 
the mucus mass or as fluid blood. Mucus is always present. 
As a rule the stools are green in color. Symptoms in 
chronic cases do not differ except in severity. 

Treatment: Prophylactic: The patient should be isolated; 
the evacuations and bed linen should be disinfected; and 
contamination of food and water supply must be guarded 
against. 

Curative: The patient should not be allowed to get up; 


DYSPNEA 


rest in bed is essential. The diet should consist of broths, 
strained gruels, barley, rice, and albumin water. Milk is 
not a suitable food during the height of the disease. The 
mouth should be kept clean. For the abdominal pain, hot 
fomentations or a hot water bag often gives relief. When 
the tenesmus is great, morphine grain may have to 
be given. After stool the patient should be bathed with 
soap and water and a dusting powder used to protect the 
skin surrounding the anus, and soft cotton used instead 
of paper. Prolapsed anus should be reduced wfth com¬ 
presses moistened in warm salt solution. If vomiting is 
troublesome, nothing should be given by mouth, but fluid 
should be supplied by enemas or subcutaneously. Enemas 
of normal salt solution are stimulating and give the patient 
a few hours’ rest. The medicinal treatment consists in early 
purgation; Magnesium Sulphate or Sodium Phosphate is 
best; they clear the colon of irritating matter, and, as the 
bacilli occur only in the intestines, they are carried away 
with the movements. The Magnesium Sulphate should be 
given in 2 dram doses every 2 hours until the stools lose 
their dysenteric character; then the dose is to be reduced 
and continued another day. Calomel may be used instead 
of the salts. After the character of the stool has changed, 
astringents are used, such as Bismuth Subnitrate 30 to 
60 grains every 4 hours. 

DYSMENORRHEA 

See Menstruation. 

DYSPEPSIA 

See Stomach. 


DYSPNEA 

Dyspnea means difficult breathing. This condition re¬ 
sembles the “breathlessness” or being “out of breath” 
which we have all experienced from climbing several flights 
of stairs rapidly or from running a distance to “catch a 
car,” but instead of being temporary and of short duration 
it continues hour after hour and day after day. 

The respirations are almost always rapid and deeper and 
are usually accompanied by pain. Every breath is quick 
and labored, performed with great difficulty and only after 
a hard struggle so that the patient is exhausted with the 
prolonged effort. Dyspnea is caused by an increase of car¬ 
bon dioxide and a decrease of oxygen in the blood resulting 
from incomplete metabolism. 

The symptoms are rapid, labored breathing, with a dis¬ 
tinct, audible sound; the lips are usually blue or a dusky 


DYSPNEA 


color; the face has a distressed, anxious expression; the 
eyes are prominent; unusual muscles are forced into action; 
the nostrils dilate; the upper part of the chest is greatly 
expanded by the action of muscles at the sides of the 
throat (the sternocleidomastoids) attached to the sternum, 
clavicle and. mastoid bones; the diaphragm contracts with 
force and the abdominal walls protrude, so that each breath 
is drawn with “heavings” of the chest and abdomen. Fre¬ 
quently the dyspnea is so severe that the patient can only 
breathe when sitting up and so is obliged to sit up night 
and day. This condition is called orthopnea. 

Dyspnea may affect inspiration or expiration or the whole 
act may be a struggle. 

Inspiratory dyspnea is usually due to spasm or to ob¬ 
struction in the air-passages, as in croup, edema of the 
glottis, diphtheria, and whooping cough. It gives rise to 
a very characteristic sound—high-pitched, crowing, harsh, 
and grating (stridulent breathing) as the whoop in whoop¬ 
ing cough. In coma, apoplexy, or profound unconscious¬ 
ness from any cause, each inspiration may be accompanied 
by a loud, snoring sound and the cheeks puff out at each 
breath. This is called stertorous breathing and is due to 
the vibrations of the relaxed soft palate. 

Expiratory dyspnea occurs in asthma and in chronic bron¬ 
chitis. In asthma the air seems to enter rather easily, but 
a spasmodic contraction of the bronchial muscles narrows 
the tubes so that expiration is painfully prolonged and 
“wheezing.” In bronchitis the tubes are partially closed 
and contain secretions so that the sound is “wheezing” and 
the rattle of bubbles (air in fluid) may be heard all over. 
In diseases of the respiratory tract, near approaching death, 
when the fluid in the trachea and bronchi is abundant, this 
rattling, bubbling sound may be heard at a distance, and is 
spoken of as the “death-rattle.” In pneumonia the breath¬ 
ing is shallow, difficult and painful, and each expiration is 
made with a characteristic “grunting” sound of discomfort. 
It is really a little moan from pain. 


E 


EAR NURSING 

In the nursing of ear cases we are dealing more or less 
with pus infections, but this does not prohibit us from ob¬ 
serving to the best of our ability a certain degree of 
technique. 

Earache. —An earache should never be treated as a 
trivial matter; a few hours of neglect may result in serious 
complications. After a patient complains of an earache, 
the temperature should be taken and an immediate report 
made to the doctor. A few drops of hot saline and cotton 
can be put into the canal, but under no consideration should 
heat, ice bag, morphine, codeine or any of the coal tar 
products be administered, as local applications diminish the 
tenderness and relieve the pain without stopping the prog¬ 
ress of the disease, masking the symptoms to a dangerous 
degree. Acute middle ear infections are promptly relieved 
as a rule by a myringotomy. The infection usually ceases 
and the patient recovers in from two days to two weeks. 

Preparations for a Myringotomy; The patient’s ear 
should be irrigated with a solution, temperature no° F., 
and tray made ready with the following articles: Light, 
head mirror, i set of ear specula, myringotome, bayonet- 
forceps, scissors, cotton applicator, cotton alcohol, peroxide. 
Pomeroy syringe, glass bowl for irrigation, sterile towels, 
culture tubes and glass slides. Immediately after the opera¬ 
tion the canal should be syringed with moderate force to 
prevent bloodclot from blocking the incision. Occasionally 
a moist gauze drain is introduced into the canal. It is 
hardly possible to give a definite line of symptoms for 
mastoiditis, as two cases are hardly ever alike. 

Ear Douche: In the administering of an ear douche the 
necessary precautions should be taken as to temperature 
(no° F.), and height of douche bag 2 to 3 feet above the 
level of the patient’s head. 

Method of Holding the Auricle: The canal should be 
straightened by holding the auricle backward and downward 


ECHOLALIA 


in an infant, in adult upward and backward. Wipe out the 
canal with cotton and place a piece in the opening. Note 
the discharge on cotton at the next irrigation. 

Mastoid Preparation: In the preparation of patients for 
mastoid operations there is a great difference of opinion 
amongst doctors, especially with female cases, as to the 
area which should be prepared. As this is many times 
of more importance to the patient than the operation it 
seems advisable to let the doctor decide about the prepara¬ 
tion. If left to your own discretion do the usual prelimi¬ 
nary preparation as to bath, enema, etc., and shave from 
i y 2 to 2 inches from the auricle, leaving a lock of hair 
in front on female patients. Cleanse the area shaved with 
a disinfectant solution and send to operating room where 
usually an iodine preparation, 3 per cent., is used. Omit 
dressing unless there is an open wound. 

Mastoid Dressing Tray: Add to the myringotomy tray— 
mastoid dressings, plain and iodoform packing, 2 inch band¬ 
age, two medicine glasses. 

Bandaging of an Ear: The necessary precautions in band¬ 
aging an ear are bandaging the auricle backwards with a 
figure-of»-eight, using a 2 inch bandage. (See Bandages.) 

Foreign Bodies in the Canal: No one but an experienced 
otologist should ever attempt their removal with a pair 
of forceps or a hook, but in nearly every case foreign 

bodies can be removed by syringing with water. Peas, 
beans and bodies that may swell if kept moist can be 
syringed with a small amount of alcohol if the first attempt 
fails. 

Impacted Cerumen can be removed by syringing with a 
Pomeroy syringe using a warm solution of bicarbonate 
of soda (2 drams to 1 quart of water). 

Frost Bites: The margin of the helix or rim of the 
auricle is the part first affected. The ear becomes yellowish 
white and, if badly frozen, may become brittle. The most 
important thing is to keep the patient from a warm 

room until the circulation is restored by friction gently 
applied with snow or ice and then ice water and keep 
cool. 

Post-operative Treatment of mastoid cases consists 

largely of rectal temperature every three hours the first 

five days after operation, outer dressing the first day, full 
dressing the second day. Watch for symptoms of compli¬ 
cations. Watch for facial paralysis and hemorrhage, pos¬ 
sibly from the lateral sinuses. 

ECHOLALIA 


See Suggestibility. 


ECLAMPSIA 


ECHOPEAXIA 

See Suggestibility. 

ECLAMPSIA 

Eclampsia may be denned as an acute toxemia occurring 
during pregnancy, during labor, or in the puerperium, char¬ 
acterized by convulsions and coma. It must be borne in 
mind, however, that convulsions and coma may occur during 
pregnancy from other toxic conditions, such as hyperemesis, 
as well as from uremia and epilepsy. 

Period of Onset. —Eclampsia occurring in pregnancy is 
called ante partum, that occurring for the first time in labor 
intra partum, while that originating during the puerperium 
is known as post partum eclampsia. Ante partum eclampsia 
is rare before the sixth month of pregnancy, but becomes 
increasingly common after the seventh month. The relative 
frequency of the three varieties may be stated as 

Ante partum .20 per cent. 

Intra partum .60 per cent. 

Post partum .20 per cent. 

Etiology. —Although we do not know the cause of 
eclampsia with any certainty there are some facts with 
regard to its predisposing causes that are definitely proved. 

Primiparity. —About 80 per cent, of all cases of eclampsia 
occur in women pregnant for the first time. Presumably the 
organs of such women are less able to adapt themselves to 
the altered and increased demands put upon them. The 
disease, further, is particularly common in very young and 
very old primiparae. It is possible that increased intra¬ 

abdominal pressure may be an element, because primiparity 
has that in common with the next two predisposing causes, 
viz., Hydramnios and Multiple Pregnancy. 

Eclampsia is frequently found in association with these 
conditions. Whether the connecting cause is the increased 
intra-abdominal pressure, or the over-distension of the uterus, 
it is impossible to say. In the case of twins the increased 
metabolism may be a factor. 

Thyroid inadequacy is also to be regarded as a predis¬ 
posing factor. Women in whom there is a definite hyper¬ 
trophy of the thyroid during pregnancy rarely develop 
toxemia. There is some evidence, too, that the administra¬ 
tion of thyroid is beneficial in cases of toxemia. 

Constipation must also be regarded as predisposing to 
eclampsia, tending, as it always does, to increase a state of 
auto-intoxication. 

Symptoms and Course. — Prodromal Symptoms. —These are 
really the symptoms of preeclamptic toxemia. The most 





ECLAMPSIA 


frequent precursors of an outbreak of convulsions are dis¬ 
turbances of vision, flashes of light before the eyes, dizzi¬ 
ness, headache, vomiting, epigastric pain, and a scanty secre¬ 
tion of urine containing much albumen and little urea. 
The cause of the epigastric pain is not fully understood. In 
all probability it is a referred pain from the liver. As a 
warning symptom, however, it is of the first importance. 
Not infrequently there are slight attacks of faintness or 
dizziness closely similar to petit mat. There may be no 
prodromal symptoms. 

Actual Symptoms .—A fit is usually preceded by a few 
seconds’ restlessness, with twitching and rolling of the eye¬ 
balls. Then comes the tonic stage, which may be so brief 
as to escape notice. The body is rigid, the head thrown back, 
the eyes turned up or to the side. Respiration is stopped, 
and there may be actual opisthotonos. This is rapidly fol¬ 
lowed by the clonic stage, the twitching beginning in the 
face, and being succeeded by more violent contractions of 
the limbs. The tongue may be severely bitten, and there 
may be foaming at the mouth. The veins stand out dark 
purple, and the whole face becomes livid and horribly dis¬ 
torted. This gradually passes off, and is followed by a 
period of coma with deep, stertorous breathing. 

A fit usually lasts for a minute or a minute and a half, 
rarely longer. During it the patient is quite unconscious, 
and the pupils do not react to light. Feces and urine may 
be passed. 

The length and depth of the coma depend on the number 
of fits. It becomes deeper and longer as the fits increase in 
number and the intervals between them are shortened. In 
severe cases the fits may succeed each other so rapidly that 
there is no appreciable interval. In others the patient is 
comatose during the entire interval. In mild cases there are 
few fits at long intervals, and the patient recovers conscious¬ 
ness between them. The number of fits varies from one to 
more than one hundred. They may be excited by external 
stimuli. Labor pains may excite them, and on the other hand 
they may, and often do, stimulate labor pains, and frequently 
particularly violent and prolonged pains. If the fits continue, 
the pulse rate becomes greatly accelerated, the pulse being 
small and of very high pressure. The temperature also rises 
from interference with the heat regulating center, and very 
high temperatures may be registered in bad cases. If im¬ 
provement sets in, the pulse rate and temperature fall again. 
If improvement does not occur the heart begins to fail, and 
this is followed by edema of the lungs. Aspiration pneu¬ 
monia and cerebral hemorrhage may complicate the case. 

Diagnosis.—In making a diagnosis reliance must be placed 


ECLAMPSIA 


on the history, the symptoms immediately preceding the 
attack, and the nature of the fits if observed. The fits may, 
however, be atypical. 

The condition of the urine is of importance if the case 
has not been seen before. It is always diminished in quan¬ 
tity, and in bad cases may be entirely suppressed. Sufficient 
for a rough examination can usually be obtained by cathe¬ 
terization. It is loaded with albumen, and if boiled undiluted 
frequently turns solid. Hyaline, granular, and epithelial 
casts are numerous, as well as blood cells. If sufficient 
urine is available for a more elaborate examination, the 
total nitrogen output is found to be low, the urea dim¬ 
inished, and the undetermined or “rest” nitrogen is greatly 
increased. The ammonia coefficient is variable. 

Epilepsy can usually be diagnosed by the history, the 
presence of an aura, and perhaps of a cry at the outset of 
a fit. The state of the urine is important. The fit is usually 
a single one. Uremia cannot as a rule be diagnosed from 
eclampsia without a knowledge of the patient’s having had 
previous renal disease, and often not before the autopsy. 
Acute yellow atrophy of the liver, and acute phosphorus or 
strychnine poisoning must be borne in mind, but can usually 
be ruled out owing to their rarity. Acute meningitis, and 
cerebral tumor, may simulate eclampsia, but can generally 
be distinguished by close observation of the symptoms, and 
by appropriate special methods such as a diagnostic lumbar 
puncture or an ophthalmoscopic examination respectively. 

Eclampsism. —This term is applied to the rare condition of 
‘eclampsia without fits.” It is really an extreme degree of 
preeclamptic toxemia, the patient passing into a drowsy or 
even comatose state. Death frequently results, and post 
mortem the changes characteristic of eclampsia are found. 
The diagnosis rests on the history, the state of the urine, 
and possibly the retinal changes. 

Prognosis. —This is grave for both mother and child. 
Speaking generally the maternal mortality is about 25 per 
cent., and the fetal 50 per cent., but individual cases vary 
so much that statistics are little guide. 

The general opinion is that the prognosis is worse in 
multiparse than in primigravid women. 

It is also generally believed that the earlier the fits come 
on in pregnancy, the worse is the outlook. Ante and intra 
partum cases are usually regarded as more severe than post 
partum cases, but there is a sharp division of opinion regard¬ 
ing the prognosis in the last named. Many authorities regard 
it as the most grave variety of all. 

In ante partum cases the death or expulsion of the child is 
usually followed by the cessation of the fits, and in intra 


ECLAMPSIA 


partum cases the fits tend to stop after the uterus is emp¬ 
tied. 

Signs of good prognostic significance are (i) few fits; ( 2 ) 

long intervals between fits; (3) recovery of consciousness in 
the intervals; (4) marked general anasarca. 

Bad signs are—(1) many fits; (2) short intervals; (3) 
persistence of coma in the intervals; (4) a very small 
quantity of albumen in the urine; (5) pyrexia; (6) onset 
early in pregnancy or after the second day of the puer- 
perium; (7) high arterial pressure. 

Treatment.—This naturally falls under two heads—gen¬ 
eral medical treatment (a) of the fits, and ( b ) during the 
intervals, and, secondly, obstetrical treatment. In the de¬ 
scription of treatment that follows it must be understood 
that obstetric treatment may be adopted at any stage, either 
before, during, or after the medical treatment, according to 
the nature of the case and the opinion of the physician. 

Treatment of a fit consists in preventing the patient from 
damaging herself. A gag—the handle of a spoon wrapped in 
a towel does well—should be placed in the mouth to prevent 
the tongue from being bitten. Chloroform should be 
administered if possible. Ether is better owing to its having 
less action on the liver, but its slower action makes it 
useful only where the administration has to be prolonged. 
The patient should be placed on her side as soon as pos¬ 
sible to prevent the secretions of the mouth from running 
back into the lungs. 

Medical treatment is based upon two principles: Firstly, 
to prevent the nervous explosions by protecting the patient 
from anything that would stimulate a convulsion, and by 
administering sedatives. Secondly, to flush the toxins out 
of the body by every possible channel of elimination. 

The sedatives mostly used are morphine and chloral. 
Morphine may be given in a dose of half a grain hypoder¬ 
mically, and followed by repeated doses of % of a grain 

every two hours, not more than three grains being given in 
twenty-four hours. This satisfactorily checks the fits in 
most cases and lowers the blood pressure. An objection 
to its use is that its tendency to stop the metabolism of the 
body also diminishes the secretions and excretions. Chloral 
may also be used, thirty grains of the hydrate per rectum 
every two hours till the fits cease, not more than three 

drams being given in the twenty-four hours. It is more 

depressing to the heart than morphine and hardly so effec¬ 
tive. Ether will probably need to be used along with it, 

whereas after the morphine has produced its effect an 
anesthetic is rarely required. 

While the patient is comatose or anesthetized a stomach 


ECLAMPSIA 


tube should be passed, and the stomach washed out with 

a weak solution of bicarbonate of soda. Six ounces of mag¬ 
nesium sulphate in a saturated solution should then be 

poured down the tube and left in the stomach. Failing 

the use of the tube, one to two minims of croton oil should 
be rubbed up with a little butter and placed well to the 
back of the tongue. If. on the other hand, the patient is 
sufficiently conscious to swallow, she should be given a 
potent purge, such as six grains of calomel along with a 
dram of jalap. It is well, at the same time, to empty the 
lower bowel at once by means of large warm water enemata, 
repeated until all the solid matter is removed. Frequently 
these patients have been very constipated, and much exceed¬ 
ingly offensive matter, which must of necessity be highly 
toxic, is removed in this way. This flushing of the colon 
with hot fluid also tends to stimulate the kidneys. Their 
action may be further increased by hot fomentations or 

poultices applied to the flanks. The skin may be stimulated 
by hot packs or hot air baths, the condition of the pulse 
being carefully watched. 

Where there is very high arterial pressure, or where the 
fits continue after the birth of the child, venesection should 
be done, and ten or fifteen ounces of blood removed. This 
removes a certain amount of the toxin, and the remainder 
may then be still more diluted by the administration of 
saline per rectum very slowly (one pint in half an hour, 
repeated every four to six hours as necessary), or into the 
loose cellular tissue under the breast. Diuretic salts ( e.g. 
acetate of soda, 30 grains to the pint) may be added, and 
this is a rapid and effective method of stimulating the 
kidneys. 

Even when venesection is not practised, the adminstra- 
tion of salines per rectum or under the breast is very useful, 
having a potent diuretic influence. In view, however, of the 
tendency to edema of the lungs, this form of treatment 
should not be persisted in unless it is accompanied by free 
removal of the fluid by the kidneys, bowels, and skin. If 
this precaution be overlooked the patient will become increas¬ 
ingly waterlogged and die. 

During the acute period of the disease the patient should 
get no food of any description, for she is totally unable 
to digest it. If she is conscious she should be encouraged 
to drink as much water as possible. Care must always be 
exercised to see that she can really swallow before anything 
is given to drink. 

The condition of the heart must be carefully watched, and 
stimulants given hypodermically if necessary—strophanthin, 
digitalin, and brandy being the most useful. 


ECTOPIC GESTATION 


No active treatment should be done unless the patient is 
comatose, or under the influence of morphine or ether, other¬ 
wise the effect will be to stimulate and excite more fits. 
As soon as the active part of the treatment is finished she 
should be placed in a quiet, darkened room, under the 
charge of a skilled nurse, all external stimuli being as far 
as possible removed. The nursing is of the first importance. 
The patient must be kept on her side, and turned from one 
to the other at intervals, to let the saliva run out of the 
mouth. 

The above is an outline of a safe and rational form of 
general medical treatment. There are, however, many other 
drugs and methods that have been vaunted from time to time. 

Obstetrical Treatment. —At the outset it must be explained 
that there are two schools of opinion in regard to the 
obstetrical treatment of eclampsia. The one believes in 
emptying the uterus as soon as possible; the other believes 
in leaving the uterus severely alone, allowing labor to come 
on spontaneously and then expediting delivery. 

See Convulsions. 

ECTOPIC GESTATION 

See Extra-uterine Pregnancy. 

ECZEMA 

See Skin Diseases. 

EFFERVESCENT BATH 

See Nauheim Bath. 

EFFERVESCENT DRAUGHT 

See Saline Diuretics. 

ELATERIN 

Elaterium is the juice obtained from the fruit of 
Ecballium elaterium, or squirting cucumber. This fruit 
contains an inner sac which is filled with juice and contains 
the seeds. The dried juice is elaterium. from which is ob¬ 
tained elaterin, the active principle, which is the resinous 
substance used. 

Locally: Elaterin is very injurious to the skin. It fre¬ 

quently causes inflammation and ulcers on the fingers of 
those who constantly handle the drug. 

Internally: It is the best drug to produce fluid stools 

and is therefore used to remove fluid from the tissues in the 
cases of edema and ascites. It is also used to reduce blood 
pressure in cases of apoplexy. 

Elaterin is frequently given hypodermically. 


EMETINE 

Preparations 

Elaterin; dose % o to Vio of a grain. 

Triturate of Elaterin; dose % to i grain. It contains i 
part of elaterin to 9 parts of sugar of milk. 

ELIXIR 

Elixirs are palatable preparations of drugs. They are made 
up with alcohol, sugar and some aromatic • substance. They 
usually contain very small quantities of the drug. 

EMBOLISM, PULMONARY (POST OPERATIVE) 

See Pulmonary Embolism (Post-operative). 

EMETICS 

These are drugs which produce vomiting. There are two 
classes: (1) Local emetics which act by irritating the 
stomach, such are Mustard, Salt, Warm water, Zinc Sul¬ 
phate, Copper Sulphate, Alum, Turpeth mineral; (2) General 
or Systemic Emetics which are carried by the circulation 
to the vomiting center in the medulla. The chief general 
emetics are Ipecac, Emetine, Apomorphine, Tartar Emetic. 

Preparations 

Tartar Emetic (Antimonii et Potasii Tartras), as an 

emetic; dose % to 2 grains. 

This preparation is also contained in the compound syrup 
of squill. 

Wine of Antimony, as an emetic; dose 1 to 4 drams. 

Contains 4 parts of Tartar Emetic to 1000. 

Zinc Sulphate; dose 10 to 30 grains. 

Copper Sulphate; dose 3 to 5 grains. 

Copper sulphate is the best emetic to use in cases of 
Phosphorus poisoning. 

Alum; dose 1 dram. 

Alum is best given in molasses or in the syrup of ipecac. 

Turpeth Mineral (Yellow Mercurous Subsulphate) Hydrar- 
gyri Subsulphas Flavus; dose 1 to 5 grains. 

This is given every ten or fifteen minutes until free 
vomiting occurs. 

Warm water given continuously will also cause vomiting. 

Salt (sodium chloride) is given in solid form or in con¬ 
centrated solutions to produce vomiting. 

Mustard is frequently used to produce vomiting. A tea¬ 
spoonful to a tablespoonful of the mustard powder is given 
in tepid water, and is repeated in fifteen to twenty minutes 
if no effects are produced. 

EMETINE 

See Ipecac. 


EMMENAGOGUES 


EMMENAGOGUES 

Emmenagogues are drugs which increase menstruation. 

Many drugs, such as iron, arsenic, or strychnine, which 

improve the general condition of the patient, will increase 

menstruation. 

Many cathartics, such as castor oil or aloes, when given 

improve the general condition of the patient, will increase 

menstruation. 

Counterirritants, such as mustard or cantharides, when 
taken internally, will also increase menstruation. 

The substances used principally to increase menstruation, 
however, all contain volatile oils which are their active 
principles. The chief of these are: Savine, Rue, Tansy, 
Apiol, Pennyroyal, and Gossypium. These volatile oils 
are responsible for the following severe poisonous symptoms 
that result from large doses: 

Poisonous Symptoms of Volatile Oil Emmenagogues 

1. Abdominal pain. 

2. Nausea and vomiting. 

3. Profuse diarrhea with bloody stools. 

4. Abortion. 

5. Scanty, bloody urine. 

6. Convulsions. 

7. Unconsciousness. 

8. Collapse. 


EMPYEMA 

One of the complications that may occur in chest condi¬ 
tions is empyema, an infection of the pleural cavity. This 
is usually the result of a pneumonia and rarely occurs as 
a primary condition. 

Symptoms. —The patient gives a previous history of pneu¬ 
monia, as a rule. After the pneumonia has resolved, or even 
before this period, a sudden rise in temperature may occur, 
accompanied by fever, chills, and the physical signs of fluid 
in the pleural cavity. This collection of fluid or pus may be 
general in nature, or localized (sacculated). As pus in 
other parts of the body usually requires drainage as soon 
as it is formed, here also an attempt should be made to 
remove it. 

Treatment. —While it was customary before the war to re¬ 
sect a rib and insert a drainage tube into the pleural cavity 
as soon as a diagnosis of empyema was made, army expe¬ 
rience has taught that such radical procedure is not always 
necessary. In fact, in the beginning, it is better to draw off 
the fluid which has accumulated with a needle and syringe, 
or Potain aspirator, thereby relieving the patient, and at 


EMPYEMA 


the same time, reducing certain elements which might lessen 
the shock at the time of the future operation. It is also 
true that some of the patients recover with this simple 
aspiratory procedure, although the great majority must have 
a more radical operation performed sooner or later. The 
more radical procedure consists in the partial excision of one 
of the lower ribs so that better and more adequate drainage 
may be secured. 

Operative Treatment. —Inasmuch as these patients are in a 
weakened physical condition from their pneumonia, or from 
the absorption of the poisons of the pus in the pleural 
cavity, it is advisable not to administer a general anesthetic, 
but to employ local anesthesia. This works with remarkable 
success. 

Since the patients feel more comfortable when sitting almost 
upright, the operation is performed in this position. An 
aspirating needle with syringe locates the area of pus; its 
location is the determining factor as to which rib is to be 
partially resected. In general empyema or suppurative 
pleurisy, the incision is generally made along the eighth or 
ninth ribs. A part of the rib is removed subperiosteally, 
exposing the periosteum beneath which is the outer surface 
of the pleura. The pleura is then opened by incision and 
the pus allowed to gradually escape. A drainage tube is 
then placed into the pleural cavity. 

There are many ways of draining the thoracic cavity. 
Some employ a Brewer tube; others a simple rubber drain¬ 
age tube. In empyema cases, great care should be taken 
that the number of drainage tubes used be carefully noted 
and recorded. The pleural cavity is a notorious hiding 
place for them, and very often a lost tube is the reason 
for a persistent sinus continually discharging large quantities 
of pus. 

After-Treatment. —Inasmuch as the discharge from the 
pleural cavity is moderately free, very often the drainage 
tubes are connected with bottle drainage. Occasionally, 
when a Brewer tube is employed a piece of rubber dam is 
snugly fitted around the free end of the drainage tube, 
and the open end of the dam is placed in a bottle under 
a water level so that while the pleural fluid may escape from 
the chest no air can enter the pleural cavity. The result of 
this is that a negative pressure is soon established, the lungs 
expand earlier, and the patient’s convalescence is shortened. 

The discharge is rather copious for the first few days and 
superficial dressings must be changed and reinforced when¬ 
ever necessary. After a few days the tubes within the chest 
are gradually shortened, and as soon as the discharge is 
very thin and the temperature is normal, the tubes may be 


EMULSIONS 


withdrawn altogether. While the patients are in bed, they 
should be encouraged to breathe as deeply as possible so as 
to aid the expansion of the collapsed lung. With this end 
in view, they should blow fluids from one bottle into 
another, and children should be given those toys which 
encourage blowing, such as horns or balloons. If the tem- 



Brewer’s empyema tube. A, rubber disc resting tightly 
against parietal pleura; B, rubber disc resting tightly against 
skin; C, rubber tube connected to bottle drainage. 

(From Colp and Keller’s Textbook of Surgical Nursing) 

perature suddenly rises after the drainage has been removed, 
it simply means a reaccumulation of fluid in the pleural 
cavity, and necessitates an immediate reinsertion of the tube. 

These patients should be allowed out of bed as soon as 
possible, and wheeled into the open air. If the weather is 
clear, their beds might even be moved into the open. The 
diet should be high in carbohydrates, and tonics should be 
given to restore their lost strength. 

EMULSIONS 

Emulsions are solutions of oily substances which contain 
the oil divided up into fine globules. They are usually of a 
milky color and consistency. 

ENEMATA 

Enemata are used for various purposes, and every one 
should know how to give an enema in case of emergency, 
either as a purgative, stimulant, or for nutrition. There 
are various medicated enemata prescribed by the doctor; 
for removal of flatulence, in treatment of diarrhea, to expel 






ENEMATA 


worms, etc. Such are enemata containing turpentine, asa- 
fetida, quassia, etc., but medication does not lie within the 
province of the Nurse. The doctor will give directions when 
and how these medicated enemata are to be given. They are 
followed usually with soapsuds enema. 

Purgative enemata. Soapsuds solution to cleanse the 
bowels is made with the purest soap (generally ivory or 
castile; never use laundry soap), and about two or three 
pints of hot water, for an adult; for a child, one pint is 
sufficient. When your soapsuds solution is ready its tem¬ 
perature should be 105° F., for by the time the solution 
enters the bowels it will be much cooler. The solution is 
poured into a fountain syringe bag, or douche can, which 
is hung up about two feet above your patient. A clamp 
is necessary on the rubber tubing to regulate the flow of 
the solution. When possible use a rubber rectal tube, and 
connect it with the tube of the fountain syringe by a small 
glass connecting tube. The soft rubber rectal tube is better 
than the hard rubber end supplied with the fountain syringe 
bag, for two reasons; it will reach up higher into the bowel, 
and is so soft that it will not injure the tender mucous 
membrane lining the intestines. 

Giving the enema. Let the patient lie upon the left 
side, with knees drawn up (this will relax the muscles of 
the abdomen); protect the bed with a piece of rubber 
sheeting and a bath towel or cotton sheet. Turn down 
the bedclothes, and cover your patient with a blanket. 

Allow some of the solution to flow through the tube, so 
that all gas may be expelled; then oil the rectal tube, and 
insert gently, and slowly, without pressure. 

Should you feel any obstruction (probably caused by fecal 
matter), allow a little solution to run into the bowel, and 
it will be overcome. After the tube has been inserted 
about five or six inches, open the clamp and allow the 
solution to flow slowly. If pain is caused, shut the clamp 
on the tube and stop the current for a minute, then let it 
flow again. Never hurry the giving of an enema; allow 
about fifteen minutes; because the slower the solution enters 
the bowels the better will be the result. After removing 
the tube, press a towel against the anus. If the patient 
lies quiet and retains the enema for fifteen or twenty 
minutes, you will have a good result. 

When there is a good deal of constipation the enema will 
be more successful if given in the knee-chest position, that 
is, with the patient resting on the knees and chest in bed, 
the head very low; also use the long, flexible rubber rectal 
tube on the end of the syringe. This is called a high enema. 
Adding olive oil and glycerin to the soapsuds will prove 


ENEMATA 


effective if the simple enema is not sufficient. About one 
ounce of oil and half an ounce of glycerin is the usual 
amount. Castor oil may also be given in this way; but it is 
necessary to consult the doctor before using any medication 
besides the plain soapsuds. 

Oil enemata. Sometimes the doctor orders an oil enema 
to be given first and retained for an hour, followed by a 
soapsuds enema. In that case, six ounces of hot olive oil 
are injected first and allowed to work slowly through the 
bowels before giving the soapsuds enema. 

Starch, enemata. In cases of acute diarrhea these 
enemata are sometimes ordered, and are made by mixing 
a dessertspoonful of starch with cold water into a smooth 
paste and then adding three ounces of boiling water. Boil 
two or three minutes; add sufficient water to make the mixture 
as thick as cream. It must be as cool as 103° F. before 
using. Sometimes a Davidson bulb syringe is found best to 
give the medicated enemata, as the medication can be 
forced through the tube better than with an - irrigation bag. 
A small rubber catheter or rectal tube should be attached 
to the nozzle of the bulb syringe and inserted into the 
rectum. 

Stimulating enemata. These are given in cases of 
shock or collapse, and should be very hot, as they will be 
more easily retained. The usual amount is one tablespoonful 
of whiskey or brandy, and four ounces of very hot water, 
as hot as the patient can stand; or salt solution, is sometimes 
substituted. 

Hot water should be run through the syringe first, that 
the tube may be thoroughly heated, and the enema should 
be given with a long flexible rectal tube, as it must go into 
the upper bowel to be retained. 

Nutritive enemata. When the stomach is much disturbed 
during a severe illness so that food cannot be digested, 
or in cases of delirious patients, and after some operations 
about the mouth and throat, nutritive enemata are given 
to nourish the system. They are sometimes kept up for 
days and weeks. Various formulae are used; one of the best 
is: Peptonized milk two ounces; one tablespoonful of 
whiskey, and one egg with a pinch of salt. (Peptonized milk 
may be made with Fairchild’s tubes of peptonized powder.) 
Peptonized beef extract, or beef juice may also be used. 
The milk is heated, but not over 115 0 F., then add the 
beef if used, and the egg mixture, beating it up. A simple 
soapsuds enema once a day is necessary to wash out the 
lower bowel, when your patient is fed by nutritive enemata. 

Enemata given to children. Children do not retain the 
solution from an enema long enough to cause a proper 


ENTEROCLYSIS 


result. It is better to place the child on the bedpan before 
trying to give the enema. A rubber catheter is used instead 
of a rectal tube, and salt solution is considered less irritating 
for a child than soapsuds. (See Rectum, Administration 
of Medicines by.) 

Enemata (Post-operative) 

Especially in emergencies when the patient has not had 
a cathartic, or a thorough intestinal cleansing before the 
operation, the fecal material is apt to accumulate in the 
colon causing fermentation and often stopping the passage 
of gas or flatus by its mechanical bulk. In these conditions 
it is important to empty the lower bowel by a cathartic enema. 
The soapsuds enema is usually all that is required. But 
in those cases where the soapsuds have brought very little 
return, and the distention is still marked, and it is thought 
that fecal material is being retained, it is advisable to give 
a more purgative enema. The solutions which may be 
added to enemas may be glycerin, one ounce, or turpentine, 
Yi ounce to the pint. Milk and molasses,—four ounces of 
milk and four ounces of molasses,—make a good irritative 
enema. The magnesium sulphate enema is used now quite 
frequently,—two ounces each of water, glycerin and mag¬ 
nesium sulphate in saturated solution being employed. Some 
institutions use a mixture with oxgall in the following pro¬ 
portions: turpentine 2 drams, oxgall 2 drams, magnesium 
sulphate 4 ounces, glycerin 4 ounces. 

These purgative, irritative enemas, not only empty the 
lower bowels, but also stimulate the smooth muscles to con¬ 
tract, thus expelling the gas which has accumulated. Irrita¬ 
tive enemas for safety’s sake should be small in amount. 
The soapsuds enema, however, made from castile or ivory 
soap, is given in amounts varying from two to four pints. 
After operation, it is best to give the enema in the dorsal 
position, putting the douche pan under the patient before 
the enema is given. The returns should be watched for 
the presence of fecal material, mucus, blood, bile, and gas. 
Enemas after operation should always be ordered by the 
attending physician, and no nurse should take upon herself 
the responsibility of injecting fluid into the rectum. As a 
rule, they should not be given in rectal cases, perineorrha¬ 
phies, or resections of the colon unless absolutely essential. 

ENTAMEBIC DYSENTERY 

See Dysentery. 

ENTEROCLYSIS 


See Colon Irrigation. 


ENZYMES 


ENZYMES 

The chemical changes in the food materials, after they 
are eaten, are brought about through the action of certain 
substances known as soluble ferments or “enzymes.” These 
enzymes exist in every tissue of the body, and their province 
is to break down the food materials into simpler compounds. 


Act upon car-^ 
bohydrates 


Acts on fats * 


Act on pro 
teins 


Enzymes 


Ptyalin 


Amylopsin 


Liver diastase 


Invertase 


Maltase 


Steapsin 


Pepsin 


Trypsin 


Erepsin 


Where Found 


Salivary secre¬ 
tions 

Pancreatic 
j uice 

Liver 

Intestinal 

juice 

Intestinal 

juice 

Gastric, and 
pancreatic 
secretions 

Gastric juice 


Pancreatic 

juice 


Intestinal 

juice 


Action 


Converts 
starch to 
maltose 
Converts 
starch to 
maltose 
Converts 

glycogen to 
* glucose 
Converts 
glycogen to 
glucose and 
fructose 
Converts 
maltose to 
glucose 
Splits fats to 
fatty acids 
and glyc¬ 
erin 

Splits pro¬ 
teins to 
proteoses 
and peptones 
Splits pro¬ 
teins to 
proteoses, 
peptones, 
polypeptids 
and amino 
acids 

Splits pep¬ 
tones to 
amino acids 
and ammo¬ 
nia 






















EPILEPSY 


As Sherman has stated, “all fermentation is brought about 
either directly or indirectly by the activity of animal or 
vegetable organisms or cells. When the organisms or cells 
act directly and the chemical changes occur only in its 
presence, the fermentation is said to be due to an organized 
ferment. When the action is not brought about directly 
by the cell itself, but by means of a substance secreted by 
the cell but acting apart from it, this substance is called 
a soluble or unorganized ferment or ‘enzyme.’ ” The chief 
enzymes concerned in digestion and metabolism, their source 
and their action, may be found in the preceding table: 


See Testicle. 


EPIDIDYMIS 


See Testicle. 


EPIDIDYMITIS 


EPIGLOTTIS 

See Larynx. 

EPILEPSY 

This is a disease which is characterized by attacks of 
sudden disturbance of consciousness with or without con¬ 
vulsions and tends towards mental deterioration. 

The symptoms may be mild or severe. In the mild form 
or petit mal there may be a feeling of dizziness and tem¬ 
porary loss of consciousness with or without muscular spasm, 
or there may be slight muscular twitching with very slight 
momentary loss of consciousness, and the patient proceeds 
with whatever he was doing. 

Grand mal is the type usually seen in hospitals. The 
convulsions are severe and unconsciousness is prolonged. 
The attacks are often preceded by an “aura” or warning, 
and the patient complains of unusual sensations, numbness, 
a peculiar taste, a bright light, etc., then cries out and 
losing consciousness falls heavily, “as if shot.” This disease 
was at one time called the “falling sickness.” Injuries 
are frequent, because in falling no attempt is made to 
protect or save one’s self. The tonic stage immediately 
begins; the whole body becomes rigid, the jaws are fixed, 
the eyes open and staring or rolled backward, and the face 
becomes increasingly cyanosed due to the loss of the respira¬ 
tory movements. This stage lasts but a few seconds and is 
quickly followed by the clonic stage, marked by convulsive 
action of all the muscles, mild at first, then becoming violent, 
then less severe, and finally ceasing. The body then relaxes 
and the patient lies unconscious, breathing heavily and often 
frothing at the mouth. During the convulsion the tongue 


EPILEPSY 


is bitten and urine and feces are passed involuntarily. On 
regaining consciousness there are muscular soreness, head¬ 
ache and confusion during which certain movements may be 
automatically performed. While in this state of bewilderment 
some patients become dangerous. 

Status epilepticus is a condition in which the convulsions 
are almost continuous, one attack following another with only 
short intervals between. Consciousness is not regained, 
the temperature is high, the pulse and respirations are 
increased in rate and exhaustion may soon follow; or the 
intervals between the attacks may lengthen, the convulsions 
become less severe and recovery ensues. This condition may 
occur at any time during the course of the disease, although 
it usually proves terminal. 

Instead of the convulsions there may be certain states 
which are known as the “equivalent.” These may take 
the form of simple excitement, or of furor in which the 
patient becomes noisy, violent, destructive, even homicidal, 
refuses food, is disoriented and consciousness is clouded; 
or, of dream states in which the patient is dazed, disoriented 
and has hallucinations; or, of ecstasy in which the patient 
is extremely happy and has hallucinations—hears beautiful 
music and sees heavenly visions; or, of automatic states in 
which the personality is different, and the patient has no 
memory of his former self, wanders away, engages in un¬ 
familiar work, but lives and acts in such manner as not 
to arouse suspicion that he is in an abnormal state. 

In the intervals between attacks some epileptics are bright, 
good natured and able to carry on their regular work, but 
many others are irritable, egotistical, selfish, stubborn, 
abusive and quarrelsome, and show frequent outbursts of 
anger on very slight provocation. The mental condition 
becomes gradually weakened, and sensation, perception, atten¬ 
tion and memory show impairment. Delusions and halluci¬ 
nations may occur, but orientation is usually not disturbed. 

Nursing procedures. Carefully note the character of 
the aura and where the convulsions begin. Loosen the 
clothing about the neck and waist, so that the respiratory 
movements may be free. Place a cork or padded mouth gag 
or clothespin between the teeth to protect the tongue 
which otherwise may be badly mutilated. If the attack begins 
while the patient is eating, try to remove the food from 
the mouth and place the head as low as possible to prevent 
aspiration and choking. If the patient falls on to the floor, 
make no attempt to move him, but straighten the body and 
place in position in which least injury can be done; place 
pillows or folded blanket or garments under the head and 
arms; hold the jaw forward, wipe the mucus from the mouth 


EPINEPHRIN 


and let the convulsion work itself off. After the muscular 
movements cease, place the patient in bed, change the 
clothing, bathe the face, treat the mouth by swabbing with 
antiseptic solution and apply an ice bag or cold compresses 
to the head. 

Other nursing measures should be to establish regularity 
in diet which should be simple, of easily digested foods 
served in limited quantity, for these patients tend to overeat, 
to crowd and push the food into the mouth and choke. 
Not an uncommon occurrence when supervision is relaxed is 
the aspiration of a large bolus of food, often with fatal 
consequences. Meat should be sparingly given, and the 
evening meal should always be light, for attacks are more 
frequent during the night, and indiscretions in diet will 
often produce an attack. Regularity in bathing and elimina¬ 
tion is very important. Constipation is a common ailment 
and seems to contribute in causing attacks. Give water 
freely to drink, for this is a valuable aid in elimination. 
In status epilepticus sedatives are given per rectum, and 
the nurse may have to administer chloroform to lessen the 
severity of the convulsions, but this is never done without 
an order from the physician. 

Occupations. While some intellectual people have been 
subject to epilepsy, the general tendency is towards deteriora¬ 
tion, and in patients who come to hospital this symptom 
is more or less pronounced. The occupation must, therefore, 
be adapted to the individual patient. Some simple, easy 
work may be given, but never near a stove or radiator, hot 
water or machinery, or where there is any danger from 
falling. The use of pointed scissors or other sharp instru¬ 
ments like knives should not be permitted because of the 
danger of sudden and unprovoked attacks on other patients. 
This is especially to be guarded against after a convulsion. 

EPINEPHRIN (ADRENALIN) 

Epinephrin is an extract containing all the active prin¬ 
ciples of the suprarenal or adrenal glands of the sheep or ox. 

Adrenalin is a patented name for epinephrin. 

Appearance of the Patient 

After an intravenous or hypodermic injection of epineph¬ 
rin, '«he following effects are noticed within 15 or 20 
minutes after it is given: 

The skin becomes pale, all the visible mucous membranes, 
such as the lips and conjunctiva, become pale and blanched. 
The pupils are dilated. There is an excessive secretion of 
saliva and mucus in the mouth. 

The pulse is slow, strong, and tense; the blood pressure 


EPINEPHRIN 


being greatly increased, so that it is difficult to obliterate 
the pulse by pressure with the finger. The breathing is 
somewhat deeper. These effects wear off in an hour. 

Local action: Applied to the skin, epinephrin has no 
action. If applied to a bleeding point, it checks the bleeding 
by contracting the blood vessels. On mucous membranes: 
It makes the mucous membranes pale by contraction of the 
underlying blood vessels. 

Internal Action: In the mouth: Epinephrin contracts 

the mucous membrane, from which it may be slightly 
absorbed. 

Since epinephrin is an extract of a gland, it is digested 
by the gastric juice of the stomach. It therefore produces 
no general effects when given by the mouth. To obtain 
its effects, it must be given either intravenously, intramuscu¬ 
larly or hypodermically. 

Action after Absorption 

When given intravenously, the effects appear in about 
five to ten minutes. When given intramuscularly or hypo¬ 
dermically, the effects appear within a half hour. 

Action on the blood vessels: It makes all the small blood 
vessels, especially the small arteries, narrower by contraction 
of the small muscle fibers in their walls. The blood vessels 
in the abdomen are contracted most of all, those in the brain 
and lungs least. The coronary vessels in the heart are 
dilated, however. By the contraction of the blood vessels 
it greatly increases the blood pressure. It is the best 
drug for increasing the blood pressure. 

Action on the heart: Epinephrin makes the heart beat 
slower and stronger. 

Action on involuntary muscles: Epinephrin increases the 
contractions of the involuntary muscles of the uterus, and 
its blood vessels. The involuntary muscles of the stomach 
and intestines are relaxed, though the blood vessels in their 
walls are contracted. Action on the Pupil: The pupil of 
the eye is widened (dilated) by contraction of the radial 
fibers of the iris, or colored part of the eye. 

Action on the secretory glands: The secretions of all the 
secretory glands, except the sweat glands and the pancreas, 
are increased by epinephrin. It often causes sugar in the 
urine (glycosuria). 

The effect of epinephrin wears off very quickly; usually 
in about 15 minutes to an hour. 

Poisonous Effects 

Overdoses of epinephrin cause the following symptoms: 

1. Slow, irregular pulse. 

2. Pale, blanched skin. 


EPINEPHRIN 


3. Dilated pupils. 

From still larger doses the following symptoms will also 
occur: 

1. Rapid, weak, thready pulse. 

2. Collapse: Pale, cold, moist skin, slow and shallow 
breathing, and dilated pupils. 

A single overdose may cause such profound collapse, 
that death may result. 

Uses 

Epinephrin is used for the following conditions. 

1. To check "bleeding by contracting the bleeding vessels. 
It is only of value in bleeding from the small blood vessels. 
The bleeding may start up again, however, when the effect 
of the drug wears off, because after the blood vessels are 
contracted, they soon dilate again. 

In bleeding from the nose, stomach, intestines, uterus or 
bladder, epinephrin is very valuable, if it can be applied to 
the bleeding spot without the necessity of an elaborate 
surgical procedure. 

2. As a heart stimulant, especially where a rapid effect 
is desired. The effect soon wears off, however. 

3. Epinephrin is often used together with cocaine. It 
contracts the blood vessels, lessening the absorption of the 
cocaine, which is then less apt to cause poisonous effects. 

4. In the treatment of Addison’s disease (tuberculosis or 
cancer of the adrenal glands). It then supplies the absent 
secretion of the adrenal glands. 

Preparations 

Dried Suprarenal Glands; dose 4 grains. 

Epinephrin Chloride (1:1000 solution); dose 5 to 15 
minims. 

Adrenalin Chloride Solution; dose 5 to 15 minims. 

This is a 1:1000 solution of adrenalin chloride, the active 
principle of the suprarenal glands, in normal salt solution. 

Adrenalin Inhalant 

This is a 1:1000 solution of adrenalin chloride in oil. 

Adrenalin Ointment 

An ointment of adrenalin chloride 1:1000 in strength. 

Adrenalin Suppositories 

A 1:1000 solution of adrenalin chloride in cocoa butter. 

Adrenalin Tablets 

Each tablet contains %oo of a grain of adrenalin borate. 
Each tablet when dissolved in 15 minims of water makes 
a 1:1000 solution. 

Administration 

Epinephrin is given intravenously, intramuscularly, or 
hypodermically. When it is given intravenously, it must be 
injected very slowly, to avoid poisonous effects. 


EPSOM SALT 


For local effect, it is used in 1:15000 to 1:1000 solutions, 
preferably in oil. 


EPSOM SALT 

See Magnesium. 

EPISTAXIS 

Epistaxis or Bleeding from the Nose is a capillary hem¬ 
orrhage from a deeply congested mucous membrane. It 
may be profuse and long continued. 

Causes of Epistaxis 

1. Local causes.—Traumatism, ulceration (frequent on the 
septum), foreign bodies, new growths, picking and scratch¬ 
ing with the fingers. 

2. Constitutional causes.—Plethora, hemophilia, chronic 
anemia, preceding certain fevers especially typhoid fever, 
venous congestion occurring in cardiac or pulmonary diseases 
or cerebral congestion, puberty in delicate children especially 
those with a rheumatic tendency. There may be an heredi¬ 
tary tendency to it. 

Epistaxis may occur during sleep, the blood swallowed later 
being vomited, and so confused with hematemesis; or the 
blood may be coughed up and so confused with hemoptysis. 

Treatment. —The patient’s head should be kept erect, to 
aid the venous return. He should not bend over a basin 
or wear a tight collar. The clothes should be loosened. 
Raising the arms above the head will lessen the blood 
supply to the nose. 

The blood tends to clot and spontaneously check the bleed¬ 
ing. The patient should be warned not to blow his nose 
or in any way loosen the clots. Ice or ice compresses should 
be applied to the forehead, the bridge of the nose, and 
back of the neck. . Ice may be pressed against the nose. Very 
hot or cold water may be injected into the nostrils. 

Compression may be made on the facial artery by pressure 
on the superior maxilla near the nose on the bleeding side. 
Spunk may be inserted in the bleeding nostril. When moist, 
it swells and in this way local pressure is applied which 
helps to check the bleeding. The anterior nares may be 
packed with sterile gauze or cotton. 

Astringents may be injected, or dropped into the nostrils, 
or cotton, moistened with astringents, may be pressed into 
the nostrils. Adrenalin chloride 1:1000 solution, compound 
tincture of benzoin, Monsel’s solution, peroxide of hydrogen, 
or hamamelis, etc., may be used. Ergot may be given 
internally when bleeding continues. 

A hot foot-bath may check bleeding by dilating the blood 


ERGOT 


vessels in the extremities and drawing blood away from the 
head. When considerable blood has been lost, this may cause 
fainting, unless given in the recumbent position. 

When the above means are unsuccessful the posterior 
nares must be packed. 


ERGOT 

Ergot is a black parasitic fungus, which grows on the rye 
plant, Secale cereale, the fungus taking the place of the rye 
grain. 

The active principles are the alkaloids: ergotoxine, ergo- 
tine and tyramine. 

Appearance of the Patient. —Ergot is usually given to 
patients for bleeding from the uterus, or to contract the 
uterus immediately after childbirth. 

Within fifteen minutes to a half hour after a dose of 
a preparation of ergot is given, the patient usually complains 
of violent cramp-like pains in the lower part of the abdomen, 
particularly in the region of the uterus. If there has been 
bleeding from the uterus, this is gradually lessened. 

There may be nausea, and later, frequent movements of 
the bowels. The pulse is usually slow and strong. 

Local action: Ergot produces no effect on the skin. If 
it is given hypodermically, it is quite injurious to the tissues, 
and is apt to cause an abscess at the site in injection. On 
mucous membranes: It causes redness and swelling, with 
profuse secretion of mucus. 

Internal Action: In tbe mouth: Ergot has a very un¬ 
pleasant taste; it often increases the flow of saliva because 
of the irritation of the mucous membrane of the mouth. 

In the stomach: All the preparations except the active 
alkaloids may cause nausea and vomiting. 

In the intestines: Ordinary doses lessen peristalsis. Poi¬ 
sonous doses increase the secretions and peristalsis of the 
intestines, causing frequent bowel movements. 

Action after Absorption 

Action on the uterus: This is the most important action 
of ergot. Ergot increases the contractions of the uterus. 
It produces wavelike contractions of the uterine muscles, 
which expel the contents of the uterus. It does not always 
start uterine contractions, but it always increases them when 
they are once started. By contracting the uterus, ergot 
contracts its blood vessels and stops uterine bleeding. 

Action on the heart: Ergot makes the heart beat slower, 
principally as a result of its effects on the blood vessels. 

Action on the blood vessels: The blood vessels are made 
narrower, by the contractions of the small muscle fibers in 


ERGOT 


their walls. The narrow blood vessels increase the blood 
pressure, and offer a greater resistance to the contractions 
of the heart, which are then stronger and slower. The pulse 
of ergot is therefore slow and strong. The effect is similar 
to that of epinephrin or pituitary extract but is not 
as marked. 

Action on secretions: The secretion of sweat and milk 
is lessened. 

Acute Ergot Poisoning 

Acute ergot poisoning is very rare and usually occurs from 
large doses of ergot, taken to produce abortion. 

Symptoms. — i. Cramp-like abdominal pain. 

2. Vomiting. 

3. Diarrhea. 

4. Bleeding from the uterus. 

5. Abortion. 

6. Hemorrhages into the skin. 

7. Tingling and itching of the skin, or numbness. 

8. Collapse (rapid, weak pulse, cold skin, slow and shallow 
breathing, etc.). 

There may be convulsions before death. 

Treatment. —1. Wash out the stomach. 

2. The collapse is treated with heart stimulants, such as 
caffeine, strychnine, etc. 

Chronic Ergot Poisoning 

Chronic ergot poisoning results from eating rye bread 
made from rye infected with the ergot fungus. This is 
more apt to occur in the rye growing during wet seasons. 

Ergot poisoning is very common in Russia and other 
northern countries, where a good deal of rye bread is eaten. 

There are two forms of chronic ergot poisoning: 

1. The Gangrenous Form 

2. The Spasmodic Form 

Gangrenous Form 

This is due to the persistent contractions of many of the 
blood vessels. As a result, various parts of the body, such 
as the fingers, the toes, the ears or the tip of the nose may 
be deprived of their blood supply, and the part affected 
then dies or becomes gangrenous. 

Symptoms. —The limbs are first affected. The fingers and 
toes become cold, they lose their sensation, and become blue 
in color. Soon they become hard and shriveled up and 
fall off, without causing pain. Sometimes the gangrene 
spreads up over the extremities, and the forearm or leg 
may become gangrenous. Occasionally areas of gangrene 
may form in the internal organs. Ulcers in the stomach and 


ERGOT 


intestines may occur, because various areas of these organs 
are deprived of their circulation. Ulcers of the cornea 
of the eye may also result from the contraction of some of 
the small blood vessels leading to the cornea. 

Nervous or Spasmodic Form 

The symptoms of this form are believed to be due to 
spasms of the muscles in some of the small blood vessels 
of the brain. The contraction of some of these vessels 
obliterates the circulation in certain areas of the brain, thus 
causing the various symptoms. Some of the symptoms 
remain permanently. 

Symptoms.— i. Weakness. 

2. Drowsiness. 

3. Headache. 

4. Dizziness. 

5. Itching, and a feeling as if something were creeping 
over the limbs (formication). 

6. Temporary or partial blindness. 

7. Painful cramps in the limbs. 

8. Clonic convulsions, followed by epileptiform convulsions. 
The mind remains clear after the attacks, but often the 
patient becomes insane. 

The treatment varies with the symptoms. 

Uses 

Ergot is used to contract the uterus, and to prevent or 
check uterine bleeding. It should always be given when the 
uterus is empty. 

In labor cases it should always be given after the third 
stage of labor; that is, after the placenta is expelled. If 
given before the placenta is entirely expelled, the contrac¬ 
tions of the uterus may cause pieces of the placenta to 
remain in the uterus, which may become infected and cause 
sepsis. 

Ergot is frequently given to check bleeding from the 
lungs, from an ulcer of the stomach, from an ulcer of the 
intestines in typhoid fever, etc. The bleeding is checked 
by the contractions of the bleeding vessels. 

Ergotoxine and tyramine are used to increase the blood 
pressure. 

Administration 

Ergot has a very unpleasant taste which should always 
be disguised. It is best given after meals. 

When given hypodermically, it should be injected deep 
into the muscles, and the part should be massaged very 
thoroughly afterwards. 



ERYSIPELAS 


Preparations 

Pluidextract of Ergot; dose i to 2 drams. 

Wine of Ergot; dose 2 to s drams. 

This contains about 20 per cent, of ergot. 

Ergot preparations should always be fresh, as they change 
very readily and become inactive if kept for any length of 
time. 

There are a number of preparations of ergot on the 
market which are suitable for hypodermic use. There are 
other preparations which are not so nauseating and are more 
reliable than the usual preparations. Most of them are not 
official. 

Ergotoxine; dose Vioo to %o of a grain. 

This is one of the active principles or ergot and is given 
Hypodermically. 

Ergotinine Citrate; dose Vioo to V50 of a grain. 

This is an alkaloid which is changed in the body to ergo¬ 
toxine. 

Tyramine; dose 1V2 grains. 

This is one of the active alkaloids of ergot; it is used to 
contract the uterus and to increase the blood pressure. 

Purified Extract of Ergot (Bonjean’s Ergotin) ; dose 

2 to 8 minims. 

This is a purified extract of ergot about ten times as 
strong as ergot itself. It is often given hypodermically. 

Ergotole; dose 5 to 30 minims. 

This is an excellent preparation made from specially cul¬ 
tivated Spanish ergot. It is about 2^ times as strong as 
the fluidextract. It is suitable for hypodermic use. 

Emutin; dose 30 to 60 minims. 

This is a reliable preparation of ergot, which has a pleas¬ 
ant taste. It is given hypodermically in doses 5 to 10 minims. 

Cornutol; dose, hypodermically, 10 to 30 minims; dose, by 
mouth, 10 to 60 minims. 

See Labor, Management of. 

ERYSIPELAS, NURSING IN 

Erysipelas is caused by the entrance of me Streptococcus 
erysipelatis into an abrasion, cut ct scratch of the skin. It 
is at first a spreading inflammation of the skin but may 
involve the deeper tissues and cause abscess formation. It 
is rarely fatal per se to adults but is apt to recur. Infants 
infected through the cord stump rarely survive. 

Patients suffering from erysipelas should be isolated 
whether at home or in the hospital. Probably no disease is 
more dreaded in hospitals than erysipelas because of the 
disastrous results if it spreads through a surgical or maternity 
ward. 


ERYSIPELAS 


Strict isolation of the patient and assignment of a nurse 
who cares for no other case should be carried out with 
expediency. The nurse need not be isolated. All linens, 
dishes and utensils used in the care of the patient must be 
carefully disinfected and all dressings burned. 

As erysipelas is a self-limited disease internal medication 
is of very little value except for the purpose of aiding elimi¬ 
nation. Local applications of i : 5000 bichloride of mercury 
solution frequently gives much relief. A rather favorite 
application is Ichthyol ointment 1:4. If this is used the 
nurse must remember that its stain is exceedingly difficult 
to remove from linen and should request old linen for 
use for the patient. Iodine painted on the skin at the edge 
of the advancing infection is sometimes thought to prevent 
its spread. 

Since the temperature is high and the pulse rate rapid 
from the onset of the disease to the temperature crisis the 
patient is kept in bed and as quiet as possible. If the 
infection is located on the face or arms, as frequently occurs, 
there will be much discomfort from the edema. As the eyes 
may be swollen and closed, a darkened room and cold 
compresses to the eyes will be found very soothing. 

Careful bathing of such parts of the body as are not 
affected by the disease is important from the viewpoint of 
~omfort and elimination. All matters tending to worry or 
innoy the patient should be guarded against for such patients 
Ire unusually prone to be irritable over trifles. 

If albuminuria is present the protein content of the diet 
should be kept low and liquids forced. During convalescence 
the diet should be especially nourishing and well balanced 
since this is a disease which requires careful hygiene if a 
relapse is to be prevented. 

With the fall of the temperature the other symptoms 
rapidly abate tinless an abscess forms. 

Before the patient is released he should receive a careful 
soap and water bath and shampoo, followed by bichloride of 
mercury solution 1 :sooo, wrapped in a clean sheet and 
taken to an adjoining room for clean clothing. 

The room occupied by the patient must receive a most 
thorough disinfection. All blankets and pillows should be 
disinfected and sent to the laundry. The mattress should 
be sent to the autoclave or placed in direct sunshine for 
twelve hours. The walls and all woodwork in the room 
should be washed. Furniture should be washed and polished. 

Nurses need not hesitate to care for an erysipelas case 
if they are careful to protect any scratch or abrasion of 
the skin. Any nurse specializing in obstetrical cases or 
waiting for one should not accept these cases. It should 


ESCHAROTICS 


be unnecessary to remind the nurse leaving an erysipelas 
case to be sure that she has a very careful shampoo and 
bath and complete change of clothing before she accepts 
another case. 


ESCHAROTICS OR CAUSTICS 

Escharotics are substances which produce destruction or 
death and sloughing of the tissues. 

When an inflammatory process becomes sluggish or chronic, 
that is, when liquefaction and resolution are delayed and 
milder counterirritants fail to stimulate and shorten the 
process, sometimes harsher methods are resorted to in order 
to remove the unhealthy tissue and give the cells a chance 
to heal. 

Action of Escharotics.—These agents cause so much tissue 
change that counterirritation is very prolonged. They are 
very irritating and penetrating and for this reason are not 
used extensively. 

Escharotics are Applied for the following Purposes:— 

1. To stimulate healing in small superficial areas, such 
as sluggish ulcers. 

2. To destroy the poison, neutralize the effect and prevent 
the absorption of poison from dog bites or poisonous snake 
bites. 

3. To remove warts, polypi, hypertrophied tissue and an 
over-production of granulations. 

Escharotics Commonly Used:—1. Acids—sulphuric, nitric, 
salicylic, glacial acetic, carbolic. 

2. Alkalies—potassium, sodium, and calcium hydroxide. 

3. Metallic salts—silver nitrate (lunar caustic), copper sul¬ 
phate (bluestone), zinc chloride, burnt alum and arsenious 
acid. 

4. Carbon dioxide, liquid or solid. 

5. Phenol or carbolic acid. 

6. The cautery in actual contact with the tissue. 

Method of Application. —Escharotics are applied in the 

form of a solution, ointment, or solid preparation. Care 
must always be taken that the application is made to the 
local area only and that the surrounding tissue is protected. 
In some cases, when the desired result has been obtained, 
the action of the caustic is checked by neutralizing it as in 
the use of alcohol following an application of carbolic acid. 

ESERINE 

See Physostigma. 

ESOPHAGUS, BURNS OP 

The esophagus may be burned by the passage through it 
of foreign substances. This will result in an ulceration, 


ETHYLHYDROCUPREINE 


with a contracture and stricture, making swallowing rather 
difficult. 

Treatment. —If the esophagus has just been burned by 
acid, then alkali must be given in the form of a solution 
of sodium bicarbonate. If caustic alkali is the agent wnich 
has been ingested, then a diluted vinegar solution is given 
to neutralize the base. The stricture, resulting from the 
healing of the injured area of esophagus is treated by the 
passing of esophageal sounds, or bougies. These are passed 
at frequent intervals, the diameter of the bougie being 
increased in size until the esophagus has been dilated to 
normal. If the ulceration is very widespread, the dilatation 
of the esophagus is impractical, and because of its extensive 
nature, more radical procedures must be adopted. 

The patient is unable to swallow; and as he cannot be 
nourished indefinitely by rectal enemata an opening must be 
made directly into the stomach. Through this fistula the 
food may be introduced and the patient receive the proper 
nourishment for his existence. 

See Gastrostomy. 

ESOPHAGUS, FOREIGN BODIES IN 

It is very important to really ascertain that the patient 
has a foreign body, and the X-ray is a valuable aid in 
determining the presence of many varieties. Some of these 
may be removed by special instruments; for example, a coin¬ 
catcher, or by direct vision through an esophagoscope. If 
these bodies are of too great a size to be easily dislodged 
and are caught fast in the cervical region of the esophagus, 
the esophagus may be opened through the neck, and the 
object extracted. The operation is spoken of as esophagotomy. 
If the foreign body is close to the cardiac portion of the 
esophagus it may be removed indirectly via the stomach by 
a gastrostomy. 

ETHER 

See Anesthetics. 

ETHYL BROMIDE 

See Anesthetics. 

ETHYL CARBAMATE 

See Urethane. 

ETHYL CHLORIDE 

See Anesthetics. 

ETHYLHYDROCUPREINE (OPTOCHIN) 

Optochin or Ethylhydrocupreine is a substance obtained 
from the bark of a Chinese plant. It is also made from 


EUCAINE 


hydroquinine, a substance made from quinine. Ethylhydrocu- 
preine acts like quinine. It has, however, a specific destruc¬ 
tive action on pneumococci, the bacteria which cause pneu¬ 
monia. It has therefore been used in recent years as a 
specific for pneumonia. 

It is applied locally in i per cent, solutions to local infec¬ 
tions caused by the pneumococci, such as certain forms of 
corneal ulcers in the eye. 

It is given in pneumonia as a specific. The treatment 
is begun by giving 8 grains as an initial dose, followed by 
grains every 3 hours until 23 grains has been given in 
twenty-four hours. The best results are obtained when the 
drug is given early in the disease as otherwise the pneumo¬ 
cocci become resistant to it. It is also given hypodermically 
in solution or in oil. 

Poisonous Effects 

Ethylhydrocupreine is particularly apt to cause poisonous 
symptoms, which are those of quinine poisoning. It is 
especially apt to cause eye symptoms, even blindness. 

Preparation 

Ethylhydrocupreine hydrochloride (optochin) 

EUCAINE 

Eucaine is an artificial alkaloid which is used as a local 
anesthetic. It produces local anesthesia, like cocaine. It 
differs from cocaine, however, in the following ways: 

1. It does not contract the blood vessels. 

2. It slows and weakens the contractions of the heart, by 
directly affecting the heart muscle, thereby causing a slow, 
weak pulse, with low blood pressure. 

3. It does not dilate the pupil. 

Administration 

For local anesthesia in the eye, it is used in a per cent, 
solution. On other mucous membranes, it is applied in 2 to 
10 per cent, solutions. 

For infiltration anesthesia, it is used in a 1:500 to 1 
per cent, solution. 

Eucaine is not as poisonous as cocaine, and can be 
boiled. 

It is also often used in the form of an ointment for 
painful hemorrhoids. 

Preparations 

Eucaine is called beta eucaine, to distinguish it from alpha 
eucaine which was formerly used as a local anesthetic, but 
because of dangerous symptoms which it produces has now 
been given up. 


EXTRA-UTERINE PREGNANCY 


Beta Eucaine Hydrochloride. 

Beta Eucaine Lactate. This is more soluble than the 

hydrochloride salt. 

And see Cocaine. 


EUCALYPTOL 

Eucalyptol is a substance obtained from the oil of eucalyp¬ 
tus and other volatile oils. The oil of eucalyptus is the 
active volatile oil of the Eucalyptus globulus, or blue gum 
tree, which grows in southern countries and has the pe¬ 
culiar quality of absorbing moisture from the soil. It is 
therefore used to drain swamps, and it helps to purify a 
malarial district in this way; since mosquitoes develop in 
swampy regions. 

Eucalyptol produces the following effects: 

1. Locally; it acts as an antiseptic and reddens the skin 
and mucous membranes. 

2. Internally; it checks the growth of bacteria in the intes¬ 
tines and increases the secretions. 

3. After absorption it increases all the secretions, such 
as the perspiration and bronchial mucus. It also makes 
the pulse stronger and faster. 

4. It is used in the treatment of malaria, as an intestinal 
antiseptic, and is inhaled in lung abscesses and fetid bron¬ 
chitis. 

Preparations 

Eucalyptol; dose 5 to 15 minims. 

Oil of Eucalyptus; dose 5 to 15 minims. 

EXOPHTHALMIC GOITER 

See Thyroid Gland, Diseases of. 

EXTRACTS 

Extracts are solid preparations obtained by dissolving the 
drug in alcohol or water, and then evaporating the solution. 
The resulting sediment is the extract, and is usually about 
four or five times as strong as the crude drug itself. 

EXTRA-UTERINE PREGNANCY (ECTOPIC GESTATION) 

In some exceptional cases the fertilized ovum engrafts 
itself on some part other than the mucous membrane of the 
body of the uterus. Such a pregnancy is called “extra- 
uterine” or “ectopic.” According to the situation we may 
have Abdominal, Ovarian, and Tubal pregnancy. 

Signs and Symptoms.— A. Before Abortion or Rupture .— 
There may be no symptoms at all. The woman may not 
even be aware that she is pregnant. But in the majority of 


EXTRA-UTERINE PREGNANCY 


cases there are symptoms which, though 'slight in themselves, 
are, like preeclamptic symptoms, of enormous importance 
as warnings of an impending disaster. 

In the first place, there may be symptoms of early preg¬ 
nancy. If the pregnancy has existed for a sufficient length 
of time, there may be a history of one or more periods 
missed. In a number of cases, however, there is no amen¬ 
orrhea, and in others it is masked by hemorrhage from 
another cause. In some cases the bladder symptoms of early 
pregnancy are exaggerated. The sickness and other reflex 
symptoms may also be severe. 

In the second place, there may be symptoms special to 
the condition. These are two in number—hemorrhage and 
pain. The hemorrhage is due to contractions of the uterus 
squeezing the soft, unsupported decidua within it. It may 
occur as recurrent slight bleedings, but more usually it con¬ 
tinues as a slight persistent brown or dark red discharge. 
In many cases it is looked on as menstruation or as 
symptomatic of a threatened or an incomplete .uterine abor¬ 
tion, and the real cause is overlooked. Portions of the 
decidua may come away in this discharge, but this is not 
always the case. Still less is the passage of the entire 
decidua as a cast to be expected. Microscopic examination 
of decidual shreds may be of importance in the diagnosis 
from abortion, as the discovery of villi would indicate an 
intra-uterine pregnancy. 

The pain is partly a referred peritoneal pain, due to con¬ 
gestion and stretching of the tube covering, partly a colic 
from contractions of the tube and uterus. It is sharp and 
colicky in nature, usually worst over the ovarian region on 
the affected side. Frequently it is accompanied by a feeling 
of faintness or nausea. 

The physical signs on bimanual examination consist in the 
enlargement of the uterus, which is practically always present, 
and perhaps the softening of the cervix. At one side and 
rather behind the uterus is a swelling which is, in a typical 
case, rounded, rather elastic, pulsatile, and usually tender — 
the pregnant tube. 

B. At the Time of Abortion or Rupture .—Clinically it is 
impossible to distinguish between rupture and tubal abortion. 
The patient is, without any warning, seized with severe cut¬ 
ting pain in the lower abdomen, and occasionally a feeling 
as of something having given way. This is immediately 
followed by severe collapse, fainting, deadly pallor, with a 
small, thready, frequent pulse. Death may ensue without 
any rallying, and before anything can be done. Physical 
examination of the pelvis immediately after the occurrence 
may reveal the same state of matters as before rupture. 


EXTRA-UTERINE PREGNANCY 

The presence of free blood in the pouch of Douglas cannot 
be made out, but some hours later, when the blood has 
clotted, it may be felt as a doughy, semi-solid mass filling 
up the pelvis behind and to the sides of the uterus—a 
pelvic hematocele. 

In some cases the symptoms are less sudden and less 
severe. In them it is usually found that there has been an 
incomplete tubal abortion, and that the blood has formed a 
large clot encysted in a fibrinous covering around the mouth 
of the tube—a peritubal hematocele. Such cases are more 
favorable than those in which there is a sudden outpouring 
of blood intd the abdominal cavity. 

Diagnosis. —This may be a matter of great difficulty. A 
very careful study of the history should be made, as well 
as a careful and gentle bimanual examination—under an 
anesthetic if necessary. The condition may be mistaken 
for a small ovarian cyst with or without a coexisting preg¬ 
nancy, for a fibroid tumor, or for a hydrosalpinx, or even 
a pyosalpinx. In all of these the history is generally differ¬ 
ent. Much more commonly, and with much graver results, 
the condition is confused with (i) uterine abortion, and 
(2) retroversion of the gravid uterus. 

Uterine Abortion .—This condition and an early tubal 
pregnancy may have every symptom in common—signs and 
symptoms of early pregnancy, pain, hemorrhage either ir¬ 
regular or as a continuous brown discharge, passage of 
shreds of decidua, enlargement and softening of the uterus. 
Careful examination will reveal the tubal swelling. The 
detection of villi in the decidual shreds proves a uterine 
pregnancy, but their absence proves nothing. 

Retroversion of the gravid uterus is most likely to be 
confused with tubal pregnancy after rupture and the forma¬ 
tion of a hematocele in the pouch of Douglas. In both 
cases there is the history of early pregnancy and the soften¬ 
ing of the cervix. Behind the uterus there is an elastic 
swelling in both cases—the body of the uterus in the one, 
the hematocele in the other. Even before rupture the mis¬ 
take may be made, the tubal swelling being taken for the 
retroflexed body. Careful bimanual examination will reveal 
the true condition. 

Diagnosis of Rupture. —Unless the history indicates the 
condition, it may be impossible to make a more accurate 
diagnosis than that of internal hemorrhage from the rupture 
of an abdominal organ. The rupture of a gastric ulcer or 
of the appendix may thus be mistaken for it, or vice versa. 
Torsion of the pedicle of an ovarian cyst may also be mis¬ 
taken for the condition. t 

Happily the treatment in each case is the same—to open 


EYE NURSING 


the abdomen, find out the exact state of matters, and deal 
with it. 

Prognosis.—As long as an extra-uterine gestation continues 
the prognosis is very grave, for at any moment a rupture 
may occur which may easily prove fatal. The risk of opera¬ 
tion on an unruptured early pregnancy is slight in the hands 
of competent operators. 

If rupture or abortion has occurred, the gravity of the 
prognosis varies with the severity of the symptoms and the 
promptitude with which skilled treatment can be obtained. 
Even under the best circumstances the prognosis must be 
very guarded. 

Treatment.—A tubal pregnancy diagnosed before rupture 
should be removed by abdominal section at the earliest pos¬ 
sible moment. After rupture has occurred the only treat¬ 
ment is still removal of the tube. The abdomen should be 
opened without delay, the bleeding points secured, and the 
tube removed. Recovery sometimes follows the operation 
in cases that appeared quite hopeless, and it may therefore 
be said that it is never too late to operate in this condition. 
So far as the operator is concerned, success probably de¬ 

pends on making the operation as brief as is consistent 
with efficiency, and on combating the shock and collapse. 

Treatment of a tubal pregnancy that has gone beyond the 
early months—almost always a secondary abdominal preg¬ 
nancy—is a very difficult matter, and very dangerous, owing 
to the probability that the placenta has made extensive 

vascular connections with the intestines or other organs. 
At a varying time after the death of the fetus the placenta 
becomes thrombosed; it may therefore be safer to leave the 

case to go to term when a spurious labor will ensue and 

the child die. This apparent neglect of the fetal life is 
justifiable owing to the serious risk to the mother of inter¬ 
ference during the child’s life, and to the fact that even 
full-time children in such circumstances are usually deformed 
and rarely survive. Some weeks after the spurious labor 
the abdomen may be opened, and the sac and its contents 
removed as far as possible. It is usually necessary to leave 
some of the sac, stitching it to the abdominal wound, and 
packing it. Convalescence in such circumstances is at the 
best tedious. 


EYE NURSING 

One of the first and most important duties that should 
be impressed upon a nurse in the care of eye cases is 
that of perfect asepsis. The carrying out of rigid technique 
enters largely into the duties of a nurse doing eye nursing. 

Method and Articles Necessary for Cleansing an Eye: 


EYE NURSING 


A 2 per cent, solution of boric acid, temperature ioo° F., 
sterile cotton, a kidney basin to catch the solution, a sterile 
towel, and small rubber bulb syringe, should be sterilized 
for cleansing an eye. 

The Method Employed in Cleansing an Eye: —The 

nurse’s hands should be sterile, the patient should be in a 
reclining position with the infected eye down and the irriga¬ 
tion done from the inner angle to the outer angle of the 
eye, thus avoiding the entrance of infected secretions into 
the well eye. Gently wipe the eye after irrigation with a 
sterile cotton ball. A Buller’s shield made from a watch 
crystal is a good method for protecting the well eye. A 
troublesome child should be swathed. If both eyes are 
infected separate utensils are necessary. 

Application of Drops: —In applying drops to the eyes the 
best method is to draw the lower lid with a finger of 
the left hand, directing the patient to look upward. With the 
dropper in the right hand allow a drop to fall upon 
the inner surface of the lid. This is an agreeable method 
for the patient with a sensitive cornea. In instilling drops 
the point of the dropper should never be allowed to come in 
contact with the lids or eyeball. 

Care of Bottles and Solutions: —Bottles and droppers are 
cleansed by washing in soap-suds, and if there is any 
deposits in bottles or pipets use hydrochloric acid 1:3 or 
1:6, being careful to thoroughly rinse the bottles and drop¬ 
pers. The rubbers are removed from the droppers. Sterilize 
by boiling or soaking in bichloride of mercury (1:500) 
over night. 

Solutions are made from distilled water and ready for 
use. The action of atropine and cocaine is changed by heat. 
The action of light affects other drugs. Thus eserine is 
changed to a pink tint, cocaine to a blue tinge. 

All contagious eye cases should have complete isolation. 

~Ra.ndfl.ging an Eye: —This subject is important. An in¬ 
flamed eye should rarely be bandaged. It renders the eye 
hot and retains the discharges in the conjunctival sac. A 
popular method used is the figure-of-eight bandage in eye 
cases. See Bandaging. 

Preparation and Post-operative care of a Cataract Case.— 

1. Urine examined, if over 3 years of age, or younger 
if it can be obtained. 

2. Cleansing bath. 

3. Enema, if necessary. 

4. Have vision and field taken, and eye carefully exam¬ 
ined. 

5. Semi-solid lunch if the operation is to be done in the 
afternoon. 


EYES, GLASS 

If ordered to cleanse the surrounding area, wash with 
soap and water, and cleanse with i: 10,000 bichloride of mer¬ 
cury, then with sterile water. Flush the eye with a boric 
solution. 

How to Cocainize an Eye: —Cocaine 4 per cent, every 

5 minutes for 6 doses to be instilled in the eye hour before 
operation. While cocainizing, keep the eye covered with 
Knapp’s dressing. Instruct patient not to squeeze his eyes, 
and what to do after operation. If operation is on a 
woman, braid the hair on top of head, leaving space for 
bandage to pass above ear. 

First night, liquids, then semi-solid diet while in bed. 
Usually after twenty-four hours patients are allowed to 
be turned on opposite side from operation to rest the back. 
No cathartic for the first four days after operation, unless 
ordered. 

Dressing Tray for Cataract Operation:—For the dressing 

of cataract cases a tray is prepared containing bowls of 
warm boric acid solutions, absorbent cotton balls, Knapp’s 
dressings, bandages, a condensing lens, solutions of cocaine, 
atropine, eserine, argyrol, and a receptacle for soiled 
sponges and bandages. 

Foreign Body in the Eye.—Pull down lower lid and if 

the substance can be seen remove it with the pointed corner 
of a handkerchief. When it is beneath the upper lid, draw 
the upper lid out and push the lower lid up under it. 
The substance may then attach itself to the eyelashes on 
the lower lid. When any foreign body is firmly attached 
in the eyeball, place wet gauze or a wet handkerchief loosely 
over the eye and hold it on with a very light bandage until 
patient can be taken to a physician. 

It is always safe and generally successful to try to remove 
a foreign body by washing the eye out carefully (using 
weak salt and water, boracic acid solution or plain water) 
and as the fluid goes over the surface, hold the lid out 
from the eye and direct the patient to move the eyeball 
up and down. 

EYES, ARTIFICIAL, OR GLASS 

See Glass Eyes. 


F 


FAINTING 

Cause.—Loss of blood to the brain due to some dis¬ 
turbance in the circulation. 

Symptoms. —White face, feeble pulse, shallow breathing, 
giddiness to unconsciousness. 

Treatment.—Send blood to the brain by placing the 
patient in a lying-down position, and if possible with the 
head lower than the heart or if unable to do this, bend 
the head down over the knees. Provide free circulation of 
fresh air for the effect of oxygen on the blood—make a 
crowd stand aside—loosen any tight clothing—especially 
at the neck. Smelling salts may be used for inhaling— 
holding it so as not to spill the fluid. Ammonia or aro¬ 
matic spirits of ammonia can be sprinkled on a handker¬ 
chief and held to the nose likewise. When the patient 
becomes conscious, a stimulant may be given of aromatic 
spirits of ammonia (half a teaspoonful to i ounce of water), 
or alcohol (such as whiskey: i to 2 tablespoonfuls to % as 
much hot water; or a little sherry). For some time after¬ 
wards, keep the patient lying down, quiet, and warm. 

FALLOPIAN TUBES, DISEASES OF 

Any inflammation of the Fallopian tubes is spoken of as 
salpingitis. It may be acute or chronic. 

Acute Salpingitis. —This may be due to an infection oc- 
curing during labor, from unclean instruments, much in¬ 
strumentation, or a preexisting gonorrheal infection. The 
history usually given is that of a vaginal discharge, ab¬ 
dominal paiL of a colicky nature and, in addition, the his¬ 
tory of a recent labor, instrumentation, or gonorrhea. 

Treatment. —The treatment consists of absolute rest in bed 
in the Fowler’s position. Hot vaginal douches are given 
every six to twelve hours, depending upon the severity of 
the inflammation. Applications are made to the lower ab¬ 
domen, either in the form of heat or cold, and movements 
of the bowels should be assured by enemas. If the pain 
is very severe, sedatives may be given. Very often these 
cases of tubal infection are complicated by pelvic peritonitis 


FECES 


resulting in the development of a pelvic abscess. Instead 
of draining this through the abdomen, the abscess may 
often be drained through the vagina by making an incision 
between the posterior part of the cervix and the posterior 
wall of the vagina. This is known as a colpotomy. A good 
sized drainage tube is introduced into the abscess cavity, 
but because of the dependent position, the drainage tube 
will not stay in place without some special arrangement of 
a cross piece, so as to make a “T” tube. Great care should 
be taken that the vagina is kept scrupulously clean, and 
the drainage free. In order to accomplish this, vaginal 
irrigations with normal saline solution should be given 
twice a day. 

Chronic Salpingitis. —This may be a sequela of acute 
salpingitis. The tube may either be bound down with fibrous 
adhesions, or it may be dilated and filled with watery ma¬ 
terial (hydrosalpinx) ; or it may be filled with pus 
(pyosalpinx). Occasionally it may be tuberculous. 

Symptoms and Treatment. —The symptoms are backache, 
pain in the lower abdomen, menstrual disturbances, weakness, 
and vaginal discharge. Physical examination may reveal a 
mass in the pelvis. If the case is adjudged favorable for 
operation, a low laparotomy is performed with the excision 
of the affected tube (salpingectomy). There are no special 
ante-operative or post-operative measures other than those 
which have been outlined in all other abdominal operations. 

FECES 

What to Observe about the Feces.—The principal points 

to be observed in regard to the stools are the number of 
movements in twenty-four hours, and whether accompanied 
by pain or straining; the consistency, shape, color, and odor 
of the stool, and the presence of unusual matter (such as 
blood, pus, mucus, worms, etc.). The expulsion of gas or 
flatus should always be noted. 

FEEBLEMINDEDNESS 

See Mental Deficiency. 

FERRUM 

See Iron. 

FETAL SKULL 
Diameters of the Fetal Skull 

Suboccipito-bregmatic .3 $4 inches ( 9.4 cm.) 

Occipito-frontal . ^/ 2 inches (11.25 cm.) 

Occipito-mental .5J 4 inches (13 cm.) 

Biparietal .3^4 inches ( 9.4 cm.) 

Bitemporal .314 inches ( 8 cm-) 







FETAL SKULL 


Circumferences 

Suboccipito-bregmatic . 

Occipito-frontal . 

Occipito-mental . 


ii inches (27.5 cm.) 
13^2 inches (34 cm.) 
15 inches (37.5 cm.) 



Fetal skull. Regions and diameters. 



Fetal skull, seen from above. 

(From Johnstone’s Textbook of Midwifery) 
















FETUS, DEATH OF 


FETUS, DEATH 01 

Diagnosis of the Life or Death of the Fetus. —The only 

positive indications of the life of the fetus are the heart¬ 
beat and active movements. Its life should, however, always 
be assumed until its death can be diagnosed with reasonable 
certainty. In the early months this can only be done by 
noting on repeated examinations that the uterus remains 
stationary in regard to growth, and that the breasts either 
cease enlarging or grow smaller again. In the later months, 
when once the heart-sounds have been heard or the move¬ 
ments felt, their absence on repeated examination is very sus¬ 
picious. Very often the mother experiences after the death 
of the child some vague symptoms of heaviness, languor, a 
feeling of coldness, and the like. If with these there is 
retrogression of the breast conditions, the diagnosis is fairly 
certain. An offensive brown discharge, or the palpation of 
a macerated fetus through the cervix, puts the matter beyond 
doubt. 

Treatment. —A dead fetus is a source of danger, as the 
mother is very liable to septic infection. A physician should 
be called; he will remove the dead fetus and the membranes. 


FETUS, PRESENTATION AND POSITION OF 

See Presentation and Position. 

FEVER 

Fever begins in one of two ways. The onset or invasion 
(the period when the temperature is rising) may be very 
sudden and violent, as in pneumonia and scarlet fever. The 
temperature rises very abruptly, usually accompanied by a 
chill or in a child by a convulsion (an exaggerated chill), 
or it may be a gradual onset, as in typhoid. The tempera¬ 
ture rises higher each day, reaching its maximum in two 
or more days, and the other symptoms, headache and back¬ 
ache, etc., become more severe. After the temperature has 
reached its maximum it usually remains high, though there 
may be wide variations, for from a few days to two or 
three weeks. This period of more or less constantly high 
fever is called the fastigium or stadium. 

The fever will also subside in one of two ways. Like the 
onset, it may be very sudden and abrupt, the temperature 
falling 4 or 5 degrees within a few hours, and reaching 
to or below normal in from 12 to 24 hours, accompanied by 
a marked improvement in the patient’s condition—the breath¬ 
ing and pulse become more normal in rate and character, 
the patient falls into a sound sleep from which he wakens 


FEVER 


refreshed, with mind clear, a new being, normal but very 
weak. Sweating and the voiding of an increased volume 
of urine usually occur during this period. This is called 
the crisis, and it occurs in pneumonia, malaria, and scarlet 
fever, etc. The crisis is a very critical period, the outcome 
being almost certain recovery or probable death, so the 
patient must be watched very closely. He may go into 
collapse and die. 

The fever may subside very gradually, as in typhoid, the 
temperature falling step by step in a zigzag manner for two 
or three days or a week before reaching normal, during which 
time the other symptoms also gradually disappear. The 
fever is then said to subside by lysis. 

Types of Fever. —Fevers in different diseases run a char¬ 
acteristic course and are classified as “constant,” “remit¬ 
tent,” and “intermittent” according to the diurnal varia¬ 
tions. For instance, in pneumonia the temperature remains 
constantly high with only a slight (not more than 2° F.) 
variation between the morning and evening temperatures. 
This is a “constant” or “continuous” fever. Sudden 
changes during a “constant” fever usually indicate compli¬ 
cations. If the fever is extensively prolonged, it also usually 
indicates complications, frequently tuberculosis. 

The temperature curve in septic fever, remittent fever, 
and during the invasion and lysis in typhoid, shows a varia¬ 
tion of more than 2° F. and usually not less than 3 0 F. 
between the morning and evening temperatures, the lowest 
point, however, never reaching normal. This is called a 
“remittent fever.” 

In “intermittent fever” a sudden rise of temperature is 
followed by a sudden fall to or below normal, the fall 
usually being accompanied by profuse sweating. This alter¬ 
nate rise and fall of temperature may occur daily or after 
the lapse of a regular number of days, as in tertian malaria. 
The fever accompanying septic conditions, such as advanced 
tuberculosis, septicemia, and pyemia, is frequently “inter¬ 
mittent,” but may be “remittent.” A prolonged “inter¬ 
mittent” fever such as in advanced tuberculosis is fre¬ 
quently described as “hectic.” 

During convalescence from fevers there may be a recrudes¬ 
cence or recurrence. The elevation in temperature, etc., may 
be merely temporary, due to excitement as from the visit 
of friends, to overfeeding or the first solid food, to con¬ 
stipation, or to some unusual exertion, such as sitting up 
in bed, or to similar causes. Such a recurrence, however, 
should receive the most careful attention as it may mean 
a true relapse of the previous disease which must again run 
its course, or it may indicate complications. 


FIBROIDS 


FIBROIDS 

See Uterus. 

FILM ARON 

See Male Fern. 

FISTULA IN ANO 

See Ischio-rectal Abscess. 

FITS 

See Convulsions. 

FLAXSEED 

See Linseed. 

FLEAS 

See Lice. 

FLIES 

The fly that causes intestinal diseases in this zone is 
chiefly musca domestica, the house fly. It is distinguished 
from the stable fly, which latter bites, most readily by ob¬ 
serving that the house fly has depending from its head and 
enlarging towards its lower end, a proboscis, or trunk, which 
it lets down upon its food. The domestic fly has had all 
sorts of evil names thrown at it, but its chief really serious 
accomplishment against human happiness is achieved by 
carrying to food from outdoor toilets or open-air deposits 
of human feces, infectious disease germs, chiefly those of 
typhoid or dysentery. While, doubtless, the fly may carry 
tubercle bacilli from tuberculosis sputum, diphtheria from 
infected discharges on pillows, etc., the fly is not an im¬ 
portant factor in any but the intestinal diseases, since in 
the others its effects are quite overshadowed by the much 
more serious methods of transfer, mouth-spray and hands, 
which, moreover, operate between meals and in winter as 
well as summer. 

House flies carry infection on their feet and also in their 
intestines, the contents of which they deposit everywhere as 
fly-specks. These fly-specks are in part fecal, but the great 
majority are the result of a regurgitation or vomiting of 
intestinal contents. 

Flies breed by preference in horse manure, hence, about 
stables; cow manure seems to be their next choice. Gar¬ 
bage will often show maggots, but there is not much chance 


FOMENTATIONS 


that flies will develop from such maggots, if the garbage 
is in a pail, for at a certain stage it seems necessary for 
the prospective fly to enter dry soil for a time, and it can¬ 
not well do this through a pail bottom. Every one must have 
noticed how thick flies are in dry summers, how few in wet 
summers: exactly the converse of the conditions favorable 
to mosquitoes. 

To keep flies out of a house is very difficult unless there 
is perfect screening of every door and window and unless 
the screens are kept continually closed, which they never 
are, especially if children or careless adults use the screen 
doors. Once flies are admitted, the screens prevent their 
exit, and flies so trapped must be “swatted,” caught with 
flypaper, or poisoned. (Formalin, i in 40 of water, dis¬ 
posed in saucers where the flies will drink it, is quite 
efficient.) 

The most practical procedure, not to get rid of flies, but 
to make them relatively harmless, consists in so screening 
and otherwise protecting outdoor toilets that flies cannot 
get to the excrement within. Half an hour’s work ex¬ 
pended on an ordinary outdoor toilet is sufficient to make 
it safe. The rules are simple—see that no unscreened open¬ 
ing is left from the vault to the open air; screen all neces¬ 
sary openings from the vault that communicate with the 
open air, such as windows, vent pipes, air holes, etc., and 
permanently close all others, except the door; on the door 
use a door-spring or, even better, a rope-brick-pulley device 
to insure that the door of the closet is not left standing 
open. 

FLUIDEXTRACTS 

Fluidextracts are concentrated fluid preparations of drugs 
made by dissolving the crude plant drug in the fluid in 
which it dissolves most readily. The strength and char¬ 
acter of the fluid used therefore varies with each drug, and 
may be 95 per cent, alcohol, alcohol and glycerin, or dilute 
alcohol of various strength. Fluidextracts, however, are 
always 100 per cent, in strength; that is, 1 minim con¬ 
tains 1 grain and 1.0 c.c. contains 1.0 gm. of drug. 


FOMENTATIONS 

The fomentation is a clean, efficient, and economical 
method of applying moist heat by means of two or more 
thicknesses of flannel cloth or old blanket wrung as dry as 
possible out of boiling water and applied directly to the skin 
a number of times in succession. The heat and. moisture 
are retained by covering the application with a piece of dry 


FOMENTATIONS 

flannel and rubber tissue or oiled muslin. It is essentially 
a local vapor bath. 

Fomentations are Used as a Therapeutic Measure:— 

(1) To relieve pain and congestion in the adjoining parts 
by their analgesic or pain-relieving effect on the nerve end¬ 
ings, and by mechanically drawing blood from the congested 
part to the skin. They are used for this purpose in strains 
or sprains. 

(2) To relieve pain and congestion in internal organs by 
their analgesic effect on nerve endings, by reflex action, 
and by drawing blood to the skin. 

(3) To relieve distention or tympanites in pneumonia, 
typhoid, peritonitis and post-operative cases by causing the 
contraction of the smooth muscles of the intestines and the 
expulsion of the gas. 

(4) To relieve intestinal and renal colic. 

(5) To reduce a swelling; to stimulate the absorption of 
effusions or exudates; to increase the local blood supply, 
promote leucocytosis and functional activity. 

(6) To accumulate heat and raise the temperature of the 
part. 

Method of Procedure. —The essential factors to be con¬ 
sidered in making the application in order to obtain the 
desired results are: 

1. The Preparation of the Patient. —It is important to see 
that the patient is protected from exposure and chilling. 
Some doctors advise that during the treatment cold applica¬ 
tions should be made to the head, particularly if there is 
any tendency to congestion of blood in the head. 

2. The Area to be Covered. —This depends upon the ob¬ 
ject: 

(a) When the object is to cause an increased volume of 
blood in the skin and relieve congestion in the adjoining 
parts or internal organs, the fomentations must be very large 
so as to withdraw a large volume of blood. 

(b) When applied for a purely local effect, as in the relief 
of an infected finger or boil, etc., the application should not 
be larger than necessary, in order to avoid dilating the 
artery supplying the part and thus increasing the conges¬ 
tion. 

3. The solution most commonly used is plain boiling 
water. Turpentine is frequently added to abdominal stupes 
as an added irritant for the relief of distention, etc. It is 
never used for fomentations applied for the relief of pain 
or congestion of the kidneys and suppression because the 
turpentine if absorbed would have to be eliminated by the 
kidneys, and, as it is very irritating, would aggravate the 
already inflamed condition. 


FOOD 


4. The applications are made by immersing soft pieces of 
flannel (the required size) in the boiling water until thor¬ 
oughly saturated, then wringing them as dry as possible and 
applying directly to the skin. 

When turpentine stupes are ordered, the turpentine may 
be added to the boiling water in the proportions of 3 tea¬ 
spoonfuls of turpentine to 3 pints of boiling water. The 
water is allowed to boil freely again before immersing the 
flannel. Another method of applying turpentine stupes is 
to thoroughly mix one part of turpentine to two or three 
parts of olive oil for adults, and one to six or ten for chil¬ 
dren. Apply this before every second or third fomentation 
or as often as the skin will allow. 

5. The temperature of the application will vary from 140° 
to 160 0 F. They are applied as hot as the patient can stand, 
that is, hot enough to cause pain when first applied. 

6. The Care of the Skin and Protection of the Part. —The 
greatest care must be taken to prevent the skin from being 
burned. Wring the flannel as dry as possible. Apply it 
gradually and, if it causes too much pain, lift it up for a 
second and then replace it so that the skin may become 
gradually used to the extreme temperature. Oil the skin 
if tender, or if applications are made frequently. This pre¬ 
vents burning or softening of the skin. Take special care 
in distention, when the skin is apt to be stretched, also when 
the part is paralyzed, insensitive or benumbed by cold—it 
is safer to apply the fomentations at a lower temperature 
or to use plenty of vaseline. 

7. After the removal of the last hot compress, dry the 
part and leave it covered with the soft, dry, warm flannel 
to prevent chilling, but do not have it sufficiently warm to 
cause perspiration. Oil the skin if very red or tender. 

FOOD 

Food Materials. —Food is the name given to any sub¬ 
stance which, taken into the body, is capable of performing 
one or more of the following functions: 

(1) Building and repairing tissue, maintenance, growth, 
and development of the muscles, bones, nerves, and the 
blood. 

(2) Furnishing the energy for the internal and external 
work of the body. 

(3) Regulating the body processes, maintaining the proper 
alkalinity and acidity of the various fluids throughout the 
body, regulating the proper degree of temperature, and de¬ 
termining the osmotic pressure, etc. 


FOOD 


The Sources 


Proteins .... 


Carbohydrates 


Fat 9 


Iron 


from which the Chief Classes of Foods 
Are Drawn 

'Milk, cheese (especially skim-milk cheeses). 
Eggs. 

Meat (lean meat in particular). 

Poultry, game. 

Fish. 

Cereals, corn, wheat, rye, oats, etc. 

: Bread and breadstuffs (crackers, pastry, 
macaroni, cake). 

Beans, peas, lentils. 

Cotton seed. 

Nuts. 

Gelatin. 


'Wheat products (bread, cake, crackers, pas¬ 
try, macaroni, spaghetti). 

Cereal grains, breakfast foods. ' 

Corn products, corn meal, green corn. 

Rice, sago, tapioca, taro. 

Potatoes (white and sweet). 

J Starchy fruits (bananas). 

Sweet fruits (oranges, grapes, pineapples). 
Dried fruits (prunes, dates, raisins, currants). 
Sugar cane, sorghum cane. 

Sugar beets, sugar maples. 

Products made from sugar (candy, jellies, 
preserves, marmalade). 

'Butter, cream, cheese. 

Olive oil, cotton seed oil, peanut oil, corn 
oil, almond oil. 

Soy bean. 

Corn meal, cotton seed meal and flour, oat¬ 
meal. 

Pork (bacon especially), other fat meat. 

Codfish (and other fatty fish). 

Eggs (yolk). 

Cocoanut, chocolate. 

Brazil nuts, almonds, pecans, and other nuts 
rich in fat. 

'Eggs, milk, lean meat, cereal products, whole 
wheat, dried beans and peas, vegetables, 
| spinach in particular, onions, mushrooms, 

^ fruits, port wine. 








FOOD 


Calcium 


-Milk, Eggs. Soft tissues and fluids of all 
animals, skeleton and teeth of animals. 
Wheat (the entire grain), flour, oatmeal, 
polished rice. Dried beans and peas. Green 
| vegetables (beets, carrots, parsnips, tur¬ 
nips, potatoes). Fruits (apples, bananas, 
oranges, pineapples, dried prunes). Nuts 
_ (almonds, peanuts, walnuts). 


'Fat soluble “A.” 

Butter, cream, whole-milk. 
Whole-milk powder. 
Whole-milk cheese. 
Cod-liver oil, eggs. 

Brains, kidney. 

Cabbage (fresh-dried). 
Carrots, chard, lettuce. 
Spinach, sweet potatoes. 


Vitamines 


Water soluble “B.” 

Yeast (brewers’). 

Yeast cakes, yeast extract. 

Whole-milk, whey. 

Milk powder (whole and skimmed). 

Nuts, cereals (corn-embryo, wheat-embryo, 
. ..s wheat-kernel), rice (unpolished). 

Beans (kidney, navy, soy). 

Cotton seed, peanuts, bread. 

Cabbage, carrots, celery. 

Cauliflower, onions. 

Parsnips, potatoes. 

Peas (fresh), spinach. 

Rutabaga, fruit, grapefruit. 

Orange, lemon, tomato, raisins. 


Water soluble “C.” 

Fruits: Orange, lemon, tomatoes (canned). 
Tomatoes (fresh), grapefruit, limes, apples. 
Vegetables: Spinach, lettuce, cabbage (raw). 
Peas (fresh), onions, carrots, cauliflower. 
Potatoes (to a less extent). 

Whole-milk (to a less extent). 


The approximate fuel value of the food constituents is 
given as: 


Proteins .... 
Carbohydrates 
Fats . 


4 calories per gram 
9 calories per gram 
4 calories per gram 








FOOD 


A calorie is defined as “the amount of heat required to 
raise the temperature of one kilogram of water one degree 
Centigrade (or about four pounds of water two degrees 
Fahrenheit). 

The Food Requirements of the Body. —The human body 
does not use one nutrient to the exclusion of another; the 
best results are obtained from diets balanced to suit the 
needs of the body, providing the fuel and repair materials 
in the amounts which are calculated to give the maximum 
value with the minimum expenditure on the part of the 
organism. The investigators have endeavored to stand¬ 
ardize the food requirements of the body. In France 
Gautier recommends the following standards for men with 
little muscular work: 


Protein .107 grams 

Fat . 65 grams 

Carbohydrates .407 grams 

In England Playfair recommends the following standard 
for men of moderate activity: 


Protein .119 grams 

Fat . 51 grams 

Carbohydrates .531 grams 

In Germany the standard suggested by Voit for men 
at moderate muscular work is: 


Protein .118 grams 

Fat . 56 grams 

Carbohydrates .500 grams 

Atwater’s standards for American dietaries are more lib¬ 
eral than any of the others. He has suggested “that the 
standard must vary not only with the conditions of activity 
and environment, but also with the nutritive plane at which 
the body is maintained.” 


Atwater’s Standard for Men and Women with Varying 
Muscular Activities 



Protein 

Grams 

Fuel Value 
Calories 

Man with hard muscular work. 

ISO 

4150 

Man with moderately active muscular 



work . 

125 

3400 


Man at sedentary or woman with mod- 



erately active work. 

100 

2700 

Man without muscular exercise or 



woman with light to moderate work. 

90 

2450 























FOOD 


Preparation of Food 

The various methods to which food is subjected in prep¬ 
aration for human consumption may be summed up as fol¬ 
lows: boiling, simmering, steaming, baking, roasting, broil¬ 
ing, frying, sauteing. 

Boiling is cooking in water raised to the boiling point, 
2i2° F. (sterilizing). This method is commonly used in the 
cooking of starchy vegetables and cereals, and in the cook¬ 
ing of green vegetables, such as spinach, carrots, beets, corn, 
asparagus, etc. Stewing is a form of boiling. As a rule 
water is used, and the vessel is left uncovered, so that as 
the food is cookea the surplus moisture evaporates, leaving 
the food tender. Dried fruits, such as prunes and apricots, 
are prepared by this method. 

Simmering is cooking in water, the temperature of which 
is not raised to the boiling point, but kept between zoo° F. 
and 2io° F. This method is used in the preparation of eggs 
and dishes in which eggs predominate, since proteins are 
made tough if subjected to a high degree of temperature. 
Coddled eggs, for example, are prepared by placing the egg 
in a clean vessel and pouring over it the boiling water, then 
covering the vessel and allowing it to stand for ten or 
fifteen minutes. The vessel and the cold egg reduce the 
temperature of the water to about 185° or 190° F. and in 
this way prevent a toughening of the albumen of which 
eggs are chiefly composed. Soups, broths, ragouts, etc., 
are prepared by this method. 

Steaming is cooking over hot water or by steam. This 
method may be accomplished on the top of the stove in a 
“double boiler” or in the oven in a deep covered pan fitted 
with a “rack” to hold the article to be cooked. Either 
method allows the vessel in which the food is placed to be 
surrounded by boiling water, but does not insure sufficient 
heat to raise the food within to the boiling point. 

Baking and roasting are both brought about in the oven. 
Bread, biscuits, pies and other pastry, potatoes, cakes, etc., 
are baked, while meats, roast of beef, lamb, veal, mutton, 
as well as chicken, turkey, duck, and large fish are roasted. 
The heat in the oven may be intense. The outside or cut 
surface of the meat is seared, the soluble albumens are 
coagulated, thus sealing the juices within. If the meat is 
placed in a pan surrounded by cold water and then placed 
in the oven, the juices are “drawn out” in the water. These 
juices contain the flavoring matter or extractives. Meat 
;o treated is not so palatable or highly flavored as that which 
has first been subjected to intense heat, the water for the 
gravy added later. 


FOREIGN BODIES 


Frying and sauteing is cooking in hot fat. Food may be 
fried in deep fat, as is demonstrated in the cooking of 
croquettes, doughnuts, etc., or it may be sauted in butter 
or oil in a shallow frying pan or griddle. The latter method 
is used in making hashed brown potatoes, for example; also 
in the frying of griddle cakes, etc. 

Broiling. —In broiling or grilling the article to be cooked is 
exposed to direct heat, either to the blaze or to a very hot 
surface. The result is the same as in roasting. The outer 
surface is seared, sealing the juices within. Meat to be 
broiled is generally cut thinner than that to be roasted. The 
article, whether it is meat (steak or chops), birds, or chicken, 
is placed about three inches away from the flames and 
turned frequently until the surfaces are seared, after which 
the article is placed in a cooler part of the stove to allow 
the interior to be cooked. Pan broiling is done on top of 
the stove. The article to be broiled is placed directly upon 
a very hot surface, there is no grease used and the meat 
must be turned frequently to prevent burning. 

Poaching. —This term is applied chiefly to the cooking of 
eggs in a shallow pan of water heated just below the boiling 
point. To be properly poached an egg must be perfectly 
fresh, or the white and yolk will run together and present 
an unappetizing, unpalatable appearance. 

FOREIGN BODIES 

See Ear, Esophagus, Eye, Larynx, Nose, Throat. 

FORMALDEHYDE 

Formaldehyde is a gas obtained by oxidizing wood alcohol. 
A solution containing 40 per cent, of formaldehyde gas is 
called formalin. 

Antiseptic Action: Formaldehyde gas vigorously destroys 
bacteria (germicide) and checks their growth (antiseptic). 
It also neutralizes unpleasant odors (deodorant). 

Local action: Applied to the skin or mucous membranes, 
formalin hardens the tissues and checks the growth of bac¬ 
teria on the surface. When formaldehyde gas is inhaled, 
it causes stinging and prickling sensations in the nose, with 
a profuse flow of mucus from the nose, a flow of tears from 
the eyes, secretion of saliva, and excessive coughing, with 
profuse expectoration. 

Internal Action: Very small doses of formalin, when 
given internally, cause nausea and vomiting, lessen the diges¬ 
tion of food and make the pulse somewhat slower and 
weaker. 


FORMALDEHYDE 


Poisonous Effects 

Poisoning by large doses of formalin or formaldehyde gas 
occurs occasionally, and produces the following symptoms: 

1. Nausea and vomiting. 

2. Diarrhea. 

3. Shortness of breath and cyanosis (due to contracting 
the red blood cells and the formation of hematin in the 
blood). 

4. Collapse, coma, convulsions and death. 

The best antidote is ammonia water. 

Uses 

Formaldehyde gas is used principally to fumigate rooms 
and to disinfect clothing. It is generated in the following 
ways: 

1. By heating a solution of formalin in the room; 150 c.c. 
of formalin are necessary to disinfect a room of 1000 cubic 
feet of space. 

2. By heating paraform, a solid substance which liberates 
formaldehyde gas. There are numerous lamps on the 
market which liberate formaldehyde gas in this way. 

3. By a specially constructed apparatus for generating 
formaldehyde gas. The gas is allowed to enter the room 
through a rubber tube which is inserted in the key-hole. 

When disinfecting -with formaldehyde gas, the cracks in 
the door should be stuffed with cotton and the room should 
be kept closed for 24 hours. The unpleasant odor is re¬ 
moved by sprinkling ammonia water about the room. 

Formalin is used in 1:200 solutions to sterilize instruments. 
There are a number of instrument sterilizers on the market 
which generate formaldehyde gas and sterilize the instru¬ 
ments in this way. Formalin has also been used as a mouth 
wash and as a douche in 1:500 to 1:1000 solutions. 

It is occasionally used as a preservative for milk and 
other foods. A 4 per cent, solution of formalin is used to 
preserve tissues for microscopic examination. 

Preparations 

Formalin (Liquor Formaldehydi) 

This contains 37 per cent, of formaldehyde gas. 

Paraform or Paraformaldehyde; dose 5 to 15 grains. 

This is a solid substance which liberates formaldehyde 
gas on heating. It is used locally to destroy warts, and also 
internally as an antiseptic. 

FORMALIN 


See Formaldehyde. 


FOTHERGILL’S TILL 

FOTHERGILL’S PILL 

See Squill. 

FOWLER’S SOLUTION 

See Arsenic. 


FRACTURES 

A fracture may be described as a break in the continuity 
of a bone. While this condition is treated in the main by 
the surgeon, it affords great opportunity for the nurse to 
exhibit her skill not only in preparing the necessary things 
for the treatment of the fracture itself, but even more by 
conscientiously attending to those details that bring com¬ 
fort to the patient. A fracture may be simple, that is, 
only involving the bone, or it may be compound, in which 
case the skin and deeper tissues as well as the bone have 
been injured. Compound fractures are serious and dan¬ 
gerous because the broken skin affords excellent opportunity 
for the various pathogenic organisms to enter and cause 
bone infection. For the present, however, our attention will 
be confined to simple fractures, those in which' the skin is 
not directly injured, although it may be swollen, black and 
blue, and very tender to the touch. 

Simple Fractures. —The aim in all fractures is to restore 
the bone fragments as near to their anatomical condition as 
possible, and after this has been accomplished, the next 
thing to do is to keep the fragments in their reduced posi¬ 
tion. The first process is usually spoken of as “reduction,” 
and the second process as “immobilization.” 

Reduction of Fractures. —Fractures are reduced as a rule 
under general anesthesia, either gas, gas and oxygen, or 
ether. This is done because it is less painful, the patient 
is easier to control and the muscles are completely relaxed 
instead of being in a condition of spasm. Attempts at re¬ 
ductions are done by the surgeon as soon as possible after 
the injury. 

Immobilization of Fractures. —Immobilization (the means 
of keeping fractures at absolute rest) has for its ultimate 
aim the healing of the divided bone ends by the growth of 
new tissue or “callus formation.” There are many methods 
designed to hold fractures in apposition. They may be 
classified as follows: (i) bandages, (2) strappings, (3) 
splints (wood, wire and plaster), (4) extension and traction 
appliances, (5) mechanical means applied through open 
operation. 

It is a general rule in all fractures that the limb affected 
should always be placed in a position to favor the complete 
relaxation of the muscles which would have a tendency to 


FRACTURES 


pull the fragments apart, and, since the longer fragment can 
always be more easily controlled, it should be made to fol¬ 
low the position attained by the shorter fragment. 

Bandages and Strappings. —While bandages are employed 
more in sprains and dislocations, they are occasionally used 
in certain fractures. Fractures of the jaw are very often 
controlled by a simple four-tailed bandage; a fracture of the 
clavicle may be kept in position by a Velpeau bandage or 
strapping. Both the four-tailed and the Velpeau bandages 
are described under Bandaging. 

Strapping for Fractures. —This is used most frequently 
when one or more ribs are broken. It forms an efficient 
method for immobilizing the chest, at the same time per¬ 
mitting the fractured ribs to heal. It should be emphasized 
that the adhesive plaster dressing should never be directly 
applied over the area of fracture, with the exception of 
fractured ribs, because, with the swelling of the limb and 
the pressure of the adhesive, an ulceration of the skin is 
apt to ensue. The result is that a clean fracture may be 
converted into a compound one. Another rule in the 
application of adhesive dressings is that the part over 
which the adhesive is to be applied should be shaven of all 
hair. 

Splints. —“A splint is an apparatus for preventing move¬ 
ment of a joint, or between the ends of a broken bone.” 
Since materials used for splints must of necessity be hard, 
firm and unyielding, they should always be padded well. 
There is nothing more distressing than to see a patient with 
a simple fracture of the radius just above the wrist in which 
the splint was not only insufficiently padded but was applied 
too tightly. The result is a forearm which has become blis¬ 
tered, ulcerated and paralyzed from the pressure; the func¬ 
tion of the wrist being irretrievably impaired, the stiff, 
smooth fingers are an ignominious monument to the care¬ 
lessness of the surgeon and the attending nurse. Let it be 
an unfailing, unalterable rule that all fractures in splints 
of any description be regularly inspected so that the swell¬ 
ing of the part never becomes so great as to impair the 
circulation. The pulse at the wrist in fractures of the arm 
and forearm, and the pulse at the dorsum of the foot in 
fractures of the lower extremity should always be palpable 
after a splint has been applied. This is simple and safe 
assurance that the blood flow to the limb is not seriously 
impaired. Very often a patient will complain of pain in 
an area other than that of the fracture. The splint should 
always be carefully inspected to determine the source of 
the discomfort. Occasionally in circular casts, it is a good 
plan to cut a window in the plaster in the area of pain 


FRACTURES 


so as to relieve the pressure which is invariably causing the 
distress. By doing this, the incidence of ulcers from pres¬ 
sure will be reduced to the minimum. 

Before any splint is applied it is of prime importance to 
cleanse the injured part. The nurse, always being mindful 
of the injury, should do this gently and carefully, causing 
as little pain as possible. This procedure should be com¬ 
pleted by dusting the skin of the broken limb with talcum 
powder. 

Splint Materials. —Any material which is light and strong 
is suitable for a splint. The following are some of the more 
widely used materials: 

Wood. —Wood has been used for centuries to support 
broken limbs. Probably the best splints are the basswood. 
Basswood splints usually come in sizes of 18 x 4 x J 4 inches. 
When they are padded carefully with cotton, they make a 
good temporary splint, and because of the lightness of the 
wood, they can be cut to any desired size. The one great 
disadvantage is that it is impossible to mold them ac¬ 
curately. 

Plaster of Paris. —This is perhaps the most widely used 
splinting material in civilian practice, and, beyond doubt, its 
widespread application is justifiable. It is easy to obtain, 
strong, moderately light, and when soft lends itself to ac¬ 
curate and easy moulding. Plaster of Paris is best handled 
in the form of plaster of Paris bandages. The manner in 
which they are made is given under Bandaging. 

Plaster of Paris Bandages. —These are applied as any 
other bandage, the limb having been previously padded with 
non-absorbent cotton. Extreme care should be taken to 
apply the bandages smoothly, without wrinkles and rather 
snugly. The number used is dependent upon the desired 
thickness of the cast. After this has been obtained, the 
cast may be further smoothed by applying an excess of 
plaster and polishing the same with long strips of cheese 
cloth moistened with peroxide of hydrogen. Plaster usually 
dries in from one to eight hours. For the first thirty 
minutes, the limb should be held until the plaster has 
partially dried, because the cast may become distorted by 
pressure of surrounding objects. 

While it is not a universal practice, a great many surgeons 
deem it advisable to cut all circular casts in the direction of 
their longitudinal axis, in two parallel lines, diametrically 
opposed. The reason for this is obvious. Should the limb 
become swollen, the danger of any untoward complications, 
such as pressure necrosis, with a subsequent Volkman’s 
paralysis, is materially lessened. When the cast has been 
cut, a bandage is applied to hold the segments in place. 


FRACTURES 


Not only does cutting down a cast insure a “safety first” 
policy, but it becomes very convenient to do so when baking 
and massage are employed, as the cast may be quickly re¬ 
moved and efficiently reapplied after each treatment. 

If, for some reason, the surgeon should decide to leave 
the case intact, and to have it cut at a subsequent date, it 
must not be forgotten that dried plaster is almost stone-like. 

Spicas. —When a long bone is broken, such as the femur, 
or the pelvis, heavier splints are required because greater 
strength is necessary to overcome the powerful contracting 
influences of the muscles of the thigh. Splints in this region 
have but little value aside from their first aid application. 
If the surgeon desires to use plaster for these conditions 
a spica bandage of plaster of Paris is employed. These 
extend from the region of the umbilicus down to the toes 
on the affected side. 

The technic of the application of the plaster is the same, 
but there are several factors which are a little different and 
demand special mention. First the mechanical, for after all, 
plaster has only a certain tensile strength. If this is exceeded, 
the plaster is apt to crack and break, rendering the spica 
useless. In order to prevent this, it is customary to rein¬ 
force the cast, especially in the lateral region, i.e., from 
the hip to the knee and over the anterior aspect of the 
thigh. The reinforcing material may be strips of basswood, 
wire mesh, or sometimes longitudinal strips of plaster of 
Paris in the form of molded splints. Then, in applying 
the cast, inasmuch as the lower abdominal region is included, 
sufficient space must be allowed for the possible distention of 
the small and large intestines. In other words, ample room 
must be left for the patient’s appetite. This is accomplished 
by laying two or three folded towels on the abdomen, and 
winding the plaster so as to include them temporarily, 
removing them after the plaster has hardened. 

Since the spica winds about the genitals and anal orifice, 
great care must be taken that there is no undue pressure 
against these organs, and that the patient is able to defecate 
and urinate without difficulty. In children whose control 
is apt to be lax or involuntary, it is customary to coat the 
cast with shellac, thus rendering it impervious to the urine. 
Spicas, as well as all other complicated plaster work, are 
applied with great facility and more efficiently if the patient 
is resting on a “Hawley” table. 

Traction. —Traction is used to correct overlapping or over¬ 
riding bone fragments and lateral deformities. Through its 
agency, those muscles are relaxed which by their contrac¬ 
tion might have resulted in malpositions of the fracture. In 
addition, if properly applied, it automatically secures the 


FROST-BITES 


proper alignment of the bone ends and prevents the frag¬ 
ments from being displaced, thus avoiding injuries to 
muscles, blood vessels, or nerves. 

Suspension. —While traction is an important element, sus¬ 
pension has enhanced its value by rendering greater comfort 
to the patient, and making much easier the surgical dressing 
of the wounds. The limb is usually suspended to an overhead 
wooden or metal frame developed from the original Balkan 
frame. This consisted of two uprights with a cross piece 
at each foot of the bed supporting a horizontal bar. 

Open Operation for Fractures. —In these fractures, which 
are not compound, when reduction has been impossible, it is 
often necessary to perform an open operation, reduce the 
fracture under the direct vision of the surgeon, and then 
hold the fragments in place by some mechanical measure. 

FROST-BITES 

Frost-bites occur as the result of prolonged exposure to 
extreme cold. The parts of the body most commonly affected 
are the fingers, toes, ears, nose, and the skin over the 
cheek bones. These are the most exposed parts, the blood 
vessels are near the surface so quickly affected by the cold, 
and the blood is soon chilled. The circulation in the 
extremities is also apt to be poor while the ears, nose and 
cheek are not protected by clothing or hair. 

The parts affected are at first livid; later, as venous con¬ 
gestion occurs, cyanotic, swollen and pulseless, then turn 
purple and finally a greenish-black. 

Chilblains may occur in the fingers and toes as the result 
of exposure to less extreme cold, with moisture. The parts 
are at first pale due to contraction of the blood vessels and 
the resulting anemia. Later they become cyanotic and, when 
in the warmth, remain purplish but swell and become 
extremely painful and disabled. 

The treatment in the early stage of frost-bite consists of 
rubbing the part with snow or a cloth wrung out of ice-cold 
water, gradually making the applications warmer. The 
patient should not be brought into a warm room until the 
color of the part is normal, showing that the circulation 
has been reestablished. The aim is to restore the tone of 
the blood vessels and allow the blood to return gradually. 
The application of heat to a frozen part in which the vessels 
are paralyzed and engorged with venous blood would further 
reduce their tone and increase the supply of blood so rapidly 
as to cause rupture and bleeding into the tissues and almost 
certain death of the part. 

When the circulation is reestablished, a loose dressing is 
applied, with warmth and elevation of the part to improve 


GALACTAGOGUES 


the circulation. If sloughing occurs, hot antiseptic dressings 
are usually applied to hasten the separation of sloughs and 
to lessen the danger from the absorption of septic material. 
If gangrene develops it is usually of the dry type. The part 
is kept dry, may be dusted with a dry antiseptic powder, 
and covered with an absorbent cotton dressing until separa¬ 
tion takes place at the line of demarcation or, in some cases, 
it is removed by amputation. See Burns, and Ear Nursing. 

G 

GALACTAGOGUES 

Galactagogues are drugs or other agents which increase 
the secretion of milk. Most drugs are unsatisfactory for 
this purpose. Attention should be directed to the under¬ 
lying cause of the deficient secretion; and generous diet, 
milk, etc., may help. See Milk, Mother’s. 

GALL BLADDER 

Post-operative Treatment. —Operations in and about the 
gall bladder are accompanied by a great deal of shock, 
and as most operations involving the upper abdomen are 
attended by a large percentage of pneumonia, all means must 
be taken to insure perfect care of the patient, to prevent 
him from being chilled or caught in draughts. 

In those cases in which the gall bladder is drained, or 
where a cholecystotomy is performed, the end of the drainage 
tube should be inserted into a bottle so that the bile may be 
collected, its character observed, and the amount estimated. 
Occasionally, bile will leak along the side of the drainage 
tube, resulting in a general soaking and discoloration of the 
dressing. If this discharge is very marked, the superficial 
layers of the dressing may be removed and fresh compresses 
applied. 

It is important that all urine should be examined closely 
for the presence of bile, and that the stools be sent to the 
laboratory to determine whether bile is present. While the 
gall bladder is draining, the patient must be placed upon a 
diet which is poor in fat. because the bile salts which aid 
in the saponification of the fats are missing. And see Liver. 

GALL STONES 

Certainly the most frequent affection of the liver, and 
that one which most concerns the nurse, is that of gall 
stones (cholelithiasis). In this condition the gall bladder, 
or any of the bile ducts of the liver, may be the seat of 


GALL STONES 


stones. It is true that these stones may lie in the gall 
bladder and never cause any symptoms. But when the 

stone leaves the gall bladder and becomes impacted or 

caught in some of the ducts, for example, the cystic or 
common bile duct, symptoms of gall bladder colic ensue. 
If the stone is impacted in a cystic duct, the gall bladder 
may become slightly dilated with resulting pain and tender¬ 
ness in that region; if the stone becomes impacted in the 
common duct, inasmuch as the flow of bile is impeded on 

its way to the intestine, there is jaundice which may be 

very marked. As a result of the jaundice, and no passage 
of bile into the intestine, the stools are white, clay colored, 
and foul smelling; the urine is dark-brownish in color; and 
the skin is yellow, due to the deposition of the bile pigment 
in the skin itself. 

Medical Treatment. —During an attack of colic, the patient 
is given large doses of morphine and placed in bed. Over 
the region of the gall bladder it is advisable to place hot 
applications, either poultices or stupes. Following these 
attacks the patient should have a light diet with the minimum 
amount of fat. Intestinal elimination should be kept free 
by using salts, especially sodium phosphate. There is a 
popular superstition that consuming olive oil aids the free 
passage of gall stones. This is very much exaggerated and 
without scientific foundation. 

Operative Treatment. —Operative measures are employed 
when there have been repeated attacks of colic, when the 
stone has become impacted, or when the gall bladder is 
acutely inflamed or filled with pus. 

Ante-operative Treatment. —The ante-operative treatment 
is of extreme importance in jaundiced cases because jaundice 
is one of the factors which prevents or delays the clotting 
of blood. Naturally, pre-operative measures must be taken 
to ensure a lowering of the coagulation time. This may be 
accomplished by the administration of calcium lactate, horse 
serum, or transfusion. 

The position of the patient on the operating table is 
important because the gall bladder and its passages lie 
deep within the abdomen, and every effort must be made 
to make them as accessible as possible. This is attained by 
placing the patient on the table so that the gall bladder 
bridge may be elevated, thus forcing the liver forward; or a 
sand bag may be placed in the region of the eleventh or 
twelfth ribs. Both methods yield good results. 

Operations. —The operations which may be performed 
upon the gall bladder and its ducts are cholecystotomy, 
cholecystostomy, cholecystectomy, choledochotomy, and cho- 
lecystenterostomy. 


GAMBOGE 


Cholecystotomy. —This is an operation in which the gall 
bladder is opened, the stones removed, and the original 
incision in the gall bladder closed. It is not often performed 
because the gall bladder generally requires drainage. 

Cholecystostomy. —In this operation the gall bladder is not 
removed, but it is drained; the drainage is placed into the 
gall bladder itself by burying the tube with a purse-string 
suture. 

Cholecystectomy. —This procedure is the most frequent; it 
involves the removal of the gall bladder and the ligation of 
the cystic duct and the cystic artery. 

Choledochotomy. —In those cases in which the stone lies 
impacted in the common duct, the removal of the stone by 
incision of the duct is spoken of as choledochotomy. This 
operation entails drainage of the common bile duct. 

Cholecystenterostomy. —Sometimes the obstruction of the 
common duct is such that it cannot be removed; for example, 
stricture of the duct, either benign or carcinomatous. If 
the patient is suffering from intense jaundice, an attempt 
is made to short-circuit the bile. This is done by establish¬ 
ing an anastomosis between the gall bladder and the stomach 
or between the gall bladder and the small intestines. This 
operation is spoken of as cholecystenterostomy. 

GALLIC ACID 

Gallic acid is an organic acid which is usualy made from 
tannic acid by its combination with water. Gallic acid has 
a milder action than tannic acid. It is more readily 
absorbed into the blood, and is only used to check excessive 
secretion of sweat, of bronchial mucus and to check bleeding 
from the lungs or kidneys, but it is not very effective. Dose, 
5 to 30 grains. 

GAMBIR 

Gambir or pale catechu is an extract made from the leaves 
and twigs of Ouraparia gambir, an East Indian shrub. It is 
used as a powerful astringent; contracting the tissues and 
checking the secretions of mucous membranes, because of 
the tannic acids which it contains. 

Preparations 

Gambir; dose 15 grains. 

Compound Tincture of Gambir; dose 1 dram. 

Troches of Gambir, each containing 1 grain. 

GAMBOGE 

Gamboge is a gum resin obtained from the Garcinia 
hanburii, a tree of Siam. The leaves and young branches 


GARGLES 


of the tree are broken off, and the juice, which is the gum 
resin, is caught from the broken twigs in vessels and dried. 

Gamboge is one of the most violent drastic purgatives and 
may cause very severe collapse. Dose 2 to 10 grains. 

GARGLES 

Mouth washes and gargles are used for diseased conditions 
of the mouth and throat: to cause an antiseptic or a con¬ 
stricting (astringent) effect. In administering mouth washes 
and gargles it is essential to bring the drug in contact with 
every part of the lining membrane of the mouth and throat. 
This is usually accomplished by keeping the fluid in the 
mouth and moving it about by means of a current of expired 
air. 

Fluids applied in this manner do not affect the tonsils or 
pharynx to any extent, since they do not reach back far 
enough. Local applications to these tissues are best applied 
by sprays or irrigations. 

Irrigation is a very good method for applying medicines 
to the throat. It is usually done by means of a glass nozzle 
attached to an irrigating bag, with the patient lying down, the 
head on the side and the mouth and chin slightly tilted 
forward. 

GASTRITIS 

Dietetic Treatment of Acute Gastritis 

Starvation Period. —Twenty-four hours of total abstinence 
from food may seem extreme, but as a rule in acute cases 
of gastritis it is the only sane and safe method of instituting 
a diet and thus beginning to overcome the cause of the 
disturbance. After the period of starvation the diet is begun 
with caution. 

Fluid Diet.—Fluids should be given first in the form of 
well-skimmed broths, which may be reenforced with egg or 
cereal flours when the patient is very thin or anemic. 
Buttermilk, made with the Bulgarian cultures, koumiss and 
other fermented milk foods, liquid beef preparations such 
as peptonoids or panopepton, albumenized orange juice, 
cereal gruels treated with Taka diastase when it is found 
necessary, and peptonized milk. These may be given in 
from four to six ounces at a time, every two hours on the 
second day. 

Increasing the Diet. —On the third day if the attack is 
slight the diet may be increased by adding toast, softened 
with peptonized milk, an ordinary serving (3 ounces) of 
farina, cream of wheat or rice, reenforced meat broth with 
two crackers, a cup of tea and a slice of toast, and one or 
two soft-cooked eggs. If the acute symptoms are still 


GAVAGE 


present on the third day, the diet advised for the second 
day must be continued until they disappear. 

Convalescent Diet. —On the fifth day, if progress is satis¬ 
factory, lightly broiled chicken or a small piece of rare 
broiled beefsteak may be added to the diet and the meals 
reduced in number from six to four. 

Relapse. —The patient must be warned against over-eating 
or eating any of the articles which are known to cause an 
acute attack in his individual case, since one attack predis¬ 
poses to another, and chronic gastritis may develop as the 
result of the continual gastric disturbance. 

Dietetic Treatment of Chronic Gastritis. —The foods con¬ 
stituting the diet in chronic gastritis must be of the simplest 
character and prepared in the simplest manner. No fried 
foods are permissible. Pastries, griddle cakes, rich puddings 
and sauces, candies, and alcoholic beverages must be omitted 
from the diet as well as the following articles of food: pork, 
veal, shellfish except oysters, sardines, canned meats and 
canned fish, highly seasoned and spiced dishes, twice-cooked 
meats, vinegar, pickles, olives, cold slaw, pickled beets, cat¬ 
sup, mustard, coarse fibered vegetables such as cabbage, old 
onions, old turnips, and cucumbers, strong tea, coffee, or 
chocolate, rich cream or dishes made entirely of cream. 
In cases of excessive acidity due to a hypersecretion of HC 1 
the extractives of meat are contraindicated, hence all gravies 
and outside parts of roasted meat must be omitted or limited 
in the diet. 

GASTRIC, GASTRO- 

See Stomach. 

GASTRORRHAGIA 

See Hematemesis. 

GAULTHERIA 

See Salicylic Acid. 

GAVAGE 

Gavage is a word used to indicate forced feeding through 
a tube. It is a method of introducing liquid food or medi¬ 
cine into the stomach through a stomach tube for patients 
who cannot, or will not swallow food. 

It is indicated in the conditions following: 

1. In some operations on the jaw or tongue. 

2. In insanity, when the patient refuses food and is in 
danger of starving. It is also given to fasting or hunger- 
striking prisoners for the same reason. 

3. Where the feedings the patient is able to take are 
inadequate. 


GAVAGE 


4. In strictures or spasms of the esophagus when the 
patient cannot swallow food. 

5. In conditions in which patients are unconscious. 

6. In tetanus. 

7. In poisoning, to introduce an antidote for the poison. 

The necessary articles will be the same as for a lavage 

with the exception of the flask containing the nourishment, 
and as all the fluid is to be retained no pail will be required. 
The temperature of the fluid should be about 105° F. It 
should always be tested to avoid the danger of burning the 
patient. 

The tube is introduced in the same way as for a lavage. 
The stomach will probably try to get rid of it by contrac¬ 
tion of its muscular walls at first, so before introducing the 
fluid, wait a few moments until the peristalsis or unrest has 
subsided. Allow the fluid to flow in slowly, and with no force, 
so as not to excite peristalsis. Before all the liquid has left 
the funnel and tubing, pinch the tube and withdraw gently 
but quickly in order to prevent air from entering and also 
to prevent the entrance of fluid into the trachea. 

After the treatment the patient should be left comfortable, 
quiet, and undisturbed, so as to avoid the expulsion of the 
nourishment. See Lavage. 

Nasal Gavage 

In this method of feeding, liquid food is introduced into 
the stomach through a rubber catheter which is passed 
through the anterior and posterior nares and the pharynx 
into the esophagus. When forced feeding is necessary this 
method is less exhausting. 

It is indicated (1) when a patient is in a weakened condi¬ 
tion and cannot swallow food; (2) sometimes in operations 
on the mouth, such as carcinoma of the tongue, a cleft palate 
or fracture of the jaw, etc.; (3) in operations on the throat 
and sometimes after a tracheotomy; (4) in tetanus or 
meningitis with a locked jaw; (5) in forced feeding for 
irritable or violent patients; (6) in very weak infants. 

The articles required will be a medium sized rubber 
catheter with a small glass funnel attached, in a basin of 
cold water, a lubricant, a flask containing the nourishment, 
cut gauze, a paper bag, dressing rubber and drawsheet. 

The position of the patient may be lying down with the 
head turned to one side or sitting up with the head tilted 
forward. An infant should lie across the knees with its 
head turned away from the nurse. The catheter should be 
inserted in the uppermost nostril. 

The food may consist of any liquid food which will readily 
pass through the tube. 


GELSEMIUM 


The temperature of the liquid should be warm not hot. 
The lining of the nose is much more sensitive than that 
of the mouth and the danger of burning the patient is greater 
when feeding by this method. 

Method of Procedure .—When inserting the catheter direct 
it toward the septum of the nose. First lubricate it. If 
there is difficulty in passing the tube remove it and inse r t 
it in the other nostril. The septum of the nose is frequently 
deviated or deflected, making the chambers of the nose 
unequal in size. The tube should reach into the esophagus, 
so pass all the tube with the exception of a few inches 
which are necessary in manipulating the funnel. 

As the catheter is small there is considerable danger of 
its passing into the larynx, therefore when introduced observe 
the patient’s color and breathing before pouring in the 
solution, which would drown the patient if the tube should 
be in the larynx. Even a small amount of food in the lungs, 
besides being the cause of severe irritation and dyspnea, 
if allowed to remain (that is, if not coughed up), would 
decompose and probably lead to a lung abscess or septic 
pneumonia. If the tube is in the trachea a whistling sound 
will be heard when the funnel is held to the ear, while 
if in the esophagus probably a gurgling sound. 

As the tube is soft it may become coiled upon itself in 
the mouth or in the throat. If the fluid is poured in while 
the tube is in this position it will cause gagging, choking 
and gasping, and will almost certainly enter the larynx 
causing dyspnea, cyanosis and later a possible abscess and 
septic pneumonia. Look in the mouth or pass the finger 
to the back of the throat to see if the tube is in position. 
Before pouring in the solution, wait until the parts are 
at rest, until all distress has subsided and normal breathing 
is established and to make sure that the tube is in the 
esophagus. Then as a further precaution pour in only a 
few drops at first, then pour the balance in very slowly 
if there are no symptoms of choking. 

After all the fluid has left the funnel, pinch the catheter 
and quickly withdraw. 

GELSEMIUM 

Gelsemium is obtained from the roots and underground 
stems of the Gelsemium sempervirens, yellow jasmine, or 
Carolina jasmine. Its active principles are two alkaloids: 
gelsemine and gelseminine, the gelsemine being the more 
active of the two. 

Appearance of the Patient 

About fifteen minutes to a half hour after giving a dose 
of gelsemium, the patient feels tired and languid. The 


GELSEMIUM 


pulse is perhaps somewhat slower and weaker. If the 
patient has had muscular twitchings, these are lessened. 

The only local effect produced by gelsemium is the dilata¬ 
tion of the pupil, which follows its application to the con¬ 
junctiva. 

Internal Action. —When taken internally, gelsemium is 
readily absorbed into the blood in about fifteen to twenty 
minutes, and it then affects principally the muscles, the 
respiration and slightly the heart. 

Action on the muscles: Gelsemium lessens the contrac¬ 
tions of the muscles by paralyzing their nerve endings, which 
receive the impulses for their contractions. In this way it 
lessens muscular twitchings, which are very fine muscular 
contractions. 

Action on the respiration: Large doses of gelsemium 
make the breathing slow and shallow. 

Action on the circulation: The pulse is made slower and 

weaker by large doses. 


Excretion 

Gelsemium is rapidly eliminated from the body by the 
urine, usually in about two to three hours. 

Poisonous Effects 

An overdose of gelsemium usually causes the following 
serious symptoms; which may often endanger the patient’s 
life: 

Symptoms.—i. The patient becomes tired, languid and 
drowsy, but does not fall asleep. 

2. The movements of the muscles become weak and 
unsteady, the jaw drops, the eyes may be tired, or the 
eyelids may droop, and the pupils dilate. The speech is often 
indistinct, and the patient staggers as soon as he attempts 
to walk. (These symptoms are due to the beginning paraly¬ 
sis of the muscles.) 

3. Occasionally there is nausea and vomiting with profuse 
flow of saliva. 

4. The skin is moist, cold and insensitive to pain. 

5. The pulse is slow and weak. 

6. The breathing becomes very slow and shallow, and 
death results from the paralysis of the breathing. 

The patient is conscious to the last, though there may 
be partial blindness before death. 

Treatment. — 1. Wash out the stomach. 

2. Keep the patient quiet. 

3. Give artificial respiration. 

4. Heart stimulants such as atropine, strychnine, etc., 
are usually given. 


GLASS EYES 


Uses 

Gelsemium is used principally to relieve the very painful 
spasms of the muscles of the face in “tic douloureux” or 
trigeminal neuralgia. 

Preparations 

Fluidextract of Gelsemium; dose s to io minims. 

Tincture of Gelsemium; dose 5 to 15 minims. 

GENTIAN 

The root of the Gentiana lutea, or the yellow gentian of 
the Alps. 

Gentian is often used as a mild laxative. 

Extract of Gentian; dose 2 to 10 grains. 

Compound Tincture of Gentian; dose Vz to 4 drams. 

GERMAN MEASLES 

See Infectious Diseases, Course of. 

GIN 

See Alcohol. 

GINGER (ZINGIBER) 

Ginger is the dried roots of the Zingiber officinale, 
which grows in the East and West Indies. Green ginger 
is the fresh, and black ginger, the dried roots. The fresher 
it is, the more active is the ginger. It is used as a carmina¬ 
tive. 

Tincture of Ginger; dose V2 to 1 dram. 

GLASS EYES 

Care of Artificial or Glass Eyes. —An artificial eye worn 
by a patient should be washed frequently and should be 
removed every night. Patients frequently do this for them¬ 
selves but it is important for a nurse to know the proper 
method of procedure. The following instructions are taken 
from the text prepared by the Manhattan Eye, Ear and 
Throat Hospital. 

To Insert tbe Eye: —“Place the left hand flat upon the 
forehead, and with the tips of the two middle fingers raise 
the upper eyelid. With the right hand push the edge of the 
artificial eye beneath the upper lid, which may now be 
released by the fingers and allowed to drop upon the eye. 
The latter must then be supported by the fingers of the 
left hand, while with the right hand the lower lid is drawn 
forward and made to secure the lower edge of the shell, thus 
holding it firmly in place.” 


GLAUBER’S SALT 


To Remove the Eye: —“Draw down the lower lid with the 
middle finger of the left hand. Then, with the right hand, 
place the end of a small blunt instrument under the edge 
of the artificial eye, which is made to slip forward over 
the lower lid, when it will readily drop out. This maneuver 
must be carried out with care, as the eye can very easily 
be destroyed by dropping on a hard surface.” The eye 
should be put away carefully for safe keeping and to avoid 
breakage or roughening of its surface. The eye socket 
should be watched for signs of irritation or inflammation. 
In some cases mucus and tears are apt to collect between 
the stump and the shell. It is said that after a year the 
surface and edges of the eye become roughened so that 
it must be replaced by a new one to avoid irritation. 

GLAUBER’S SALT 

See Saline Purgatives. 

GLONOIN 

See Nitrites (Nitroglycerine). 

GLOTTIS 

See Larynx. 

GLUCOSIDES 

Glucosides are active principles of plant drugs which 
always form a sugar (usually glucose, or grape sugar, hence 
the name) when decomposed by acids, heat, bacteria or other 
agents. They are neutral substances, because chemically, 
they are neither acids nor alkalies. The names of all 
glucosides end in “in.” Alkaloids, properly, end in “ine.” 

GLYCERIN 

Glycerin is a liquid made by decomposing animal or 
vegetable fats. 

When applied to the skin or to a wounded surface, 
glycerin smarts and is painful for a few minutes, and then 
it softens the skin. It has the property of withdrawing 
fluid from the tissues (hygroscopic). 

It is often given internally or it is injected into the rectum. 
It then produces mild movements of the bowels without 
any colic. Dose i to 2 ounces. 

There are a number of preparations of various drugs 
made up with glycerin. They are known as glycerites. The 
chief are the glycerites of starch, and of egg yolk. 


GOLDEN SEAL 


See Glycerin. 


GLYCERITES 


GLYC 0 TH YMOLINE 

See under Boric Acid. 

GLYCYRRHIZA (LICORICE ROOT) 

Licorice is the root of Glycyrrhiza glabra, an English 
plant. Its active principle is a glucoside, glycyrrhizin. 

Applied to the skin it is soothing and protecting (demul¬ 
cent). Taken internally it is a mild purgative. 

Preparation 

Compound Licorice Powder (Pulvis Glycyrrhizae Com- 
positus) ; dose i dram. 

This contains senna, licorice root, sulphur, fennel and 
sugar. It should be given in very little water, as it may 
cause nausea, but it should always be followed by a drink 
of water. 

Licorice powder is best given at bedtime. It is an excel¬ 
lent purgative, producing frequent fluid stools without grip¬ 
ing, in about ten to fifteen hours; or in three to six hours, 
when given on an empty stomach. 

It is especially valuable in patients suffering from hemor¬ 
rhoids. The fluid stools resulting from licorice powder 
lessen the pain produced by movements of the bowels in 
cases of hemorrhoids. 

Licorice forms an ingredient of many cough mixtures. 
It lessens coughing by protecting the mucous membrane of 
the throat and larynx and thus avoiding irritation. The 
following is the most commonly used preparation contain¬ 
ing licorice: 

Brown Mixture (Mistura Glycyrrhizae Composita) ; dose 
i to 2 drams. 

This mixture is a soothing cough mixture which also 
contains opium. 


GOA POWDER 

See Chrysarobin. 

GOITRE 

See Thyroid Gland, Diseases of. 

GOLDEN SEAL 


See Hydrastis. 


GONORRHEA 


GONORRHEA 

See Venereal Diseases. 

GOULARD’S EXTRACT 

See Lead. 


GRAM’S STAIN 

The fixed film is covered with a fresh solution of anilin 
gentian violet made as follows: One c.c. of anilin oil is 
added to io c.c. of water and shaken until thoroughly 
emulsified, after which it is filtered through wet filter paper. 
One part of saturated alcoholic gentian violet is then added 
to nine parts of the filtrate. The slide is allowed to remain 
in the above dye for five minutes, after which it is immersed 
in the following iodine solution for *2 to 3 minutes. 


Iodine. 1 

Potassium iodide. 2 gm. 

Distilled water. 3 00 c.c. 


The film is then decolorized with 97 per cent, alcohol about 
one minute or until no more stain can be washed out of the 
preparation, after which it is washed in water and counter- 
stained with eosin for thirty seconds. 

This method of staining is frequently used in bacterial 
differentiation. By its means organisms are divided into two 
classes; those which retain the initial stain are spoken of 
as Gram positive and those which are decolorized and take 
the counterstain as Gram negative. Most bacteria fall de¬ 
cidedly into one class or the other; borderline cases do occur, 
however, and a few species show a tendency to change from 
Gram positive to Gram negative in old cultures. 


Classification of the Principal Pathogenic Bacteria 
According to Their Reaction to Gram’s Stain 


positive 

(Retain the violet stain) 


negative 

(Take the counterstain) 


Cocci 


Cocci 


M. tetragenus 
Pneumococcus group 
Staphylococcus group 
Streptococcus group 


M. catarrhalis 
M. gonorrheae 
M. meningitidis 
M. melitensis 





GRANATUM 


NEGATIVE 

Bacilli 

B. acidi lactici 
B. coli group 
B. dysenteriae group 
B. enteritdidis group 
B. influenzae group 
B. Koch-Weeks 
B. lactis aerogenes 
B. maligni edematis 
B. mallei 

B. Morax-Axenfeld 
B. mucosus capsulatus 
B. pertussis group 
B. pestis 
B. pyocyaneus 
B. typhosus group 

Spirillum 
S. cholerae 

GRANATUM (POMEGRANATE) 

Granatum is the bark of the stem and root of Punica 
granatum or pomegranate. Its active principles are the 
alkaloids pelletierine, or punicine, and isopunicine; and it 
also contains a large amount of tannic acid. 

Granatum and its alkaloids have a specific destructive 
action on tape worms. It has a very unpleasant taste and 
is not a safe drug to use. 

Poisonous Effects 

Overdoses of pelletierine or granatum, paralyze the nerve 
endings of the muscles, causing effects like those of curara 
poisoning. 

Symptoms. —i. Mental dullness and confusion of ideas. 

2. Dizziness. 

3. Great weakness of the limbs, even paralyses. 

4. Dimness of vision. 

5. Occasionally nausea, abdominal pain, perhaps vomiting 
and tremors of the muscles of the legs. 

Administration 

Granatum is usually given as a decoction made from 
about 1 to 2 ounces of fresh bark, in about half a pint 
of water. The drug is then given in two parts at intervals 
of an hour each, and the last dose should be followed in a 
half to two hours by a cathartic. 


POSITIVE 

Bacilli 

B. aerogenes capsulatus 
B. anthracis 
B. botulinus 
B. diphtherise group 
B. tetani 

B. tuberculosis and other 
acid-fast bacilli 


GRAND MAL 


Preparations 

Fluidextract of Pomegranate; dose 30 minims. 
Pelletierine Tannate; dose 4 grains. 

This is a mixture of all the alkaloids of pomegranate 
bark. 

See Anthelmintics. 


GRAND MAL 

See Epilepsy. 

GREGORY’S POWDER 

See Rhubarb. 

GRIFFITH’S MIXTURE 

See Iron. 

• GRINDELIA 

Grindelia is obtained from the leaves and flowers of 
Grindelia robusta, and Grindelia squarrosa, plants which 
grow on the western coast of the United States. 

It is principally used to relieve spasmodic cough by 
relaxing the spasm of the involuntary muscles of the bronchial 
tubes. 

GUARANA 

Guarana is a paste made from the seeds of Paullinia 
sorbilis, a Brazilian plant. It contains caffeine and tannic 
acid. It is used for sick headache and neuralgia. In 
Brazil it is also used to check diarrhea because of the 
tannic acid which it contains. 

Fluidextract of Guarana; dose 1 to 2 drams. 

(See Caffeine.) 


GUIACOL 

Guiacol is a colorless volatile liquid made by the distilla¬ 
tion of beechwood tar creosote. 

The action of guiacol is like that of creosote, with the 
following differences: 

1. It may be absorbed from the skin and then reduce 
temperature. 

2. Large doses often turn the urine a dark brown color and 
cause diarrhea. 

It is used for the same conditions as creosote. 

Preparations 

Guiacol; dose 8 minims. 

Guiacol Carbonate (Duotal) ; dose 5 to 20 grains. 


See Squill. 


GUY’S PILL 


H 


ILEMATOXYLON 

Haematoxylon is obtained from the wood of the logwood 
tree. It is an excellent astringent, contracting the tissues, and 
checking the secretions of mucous membranes, because of 
tannic acid which it contains. It is used to check diarrhea, 
but it is apt to stain sheets and linen a bright red color. 
It is also used in the laboratory, to stain tissues for micro¬ 
scopic examination. 

Preparation 

Extract of Haematoxylon; dose io to 30 grains. 

HALLUCINATIONS 

Hallucinations are false perceptions. These are of purely 
mental origin for there is no recognizable external stimulus 
present. A patient will see persons, animals and objects 
in the room when none are present, will hear voices and 
reply to them when no sound can be heard, feel vermin 
crawling over his skin, feel the heat of fire which he thinks 

is consuming his bed, etc. Normal persons do not have 

hallucinations, but they occur frequently in deranged condi¬ 
tions of the mind, and like illusions are held to rather 

tenaciously, and are believed in so that the conduct is often 
dominated by them. The most common hallucinations are of 
hearing, sight and touch. 

HAMAMELIS (WITCH HAZEL) 

Hamamelis or witch hazel, is obtained from the leaves, 
bark and twigs of Hamamelis virginiana, an American 
plant. It contains tannic acid and a volatile oil. 

It contracts the tissues and checks the secretions of 
mucous membranes. It is used to check bleeding and to 
lessen inflammations. 

Preparations 

Fluidextract of Witch Hazel Leaves; dose 30 minims. 

Extract of Witch Hazel; dose 2 drams. 

This is a colorless alcoholic fluid made by distilling the 
leaves and twigs of witch hazel. It contains very little 
tannic acid and a volatile oil. 

HARRISON LAW 

The Harrison Law went into effect March 1, 19x5. It 
was passed to regulate the sale and use of habit-forming 


HARRISON LAW 


drugs such as opium, cocaine, or their derivatives, so as to 
prevent the occurrence of the habit. The following are 
the essential features of the law: 

1. Every wholesale and retail druggist who sells opium, 
cocaine, or their derivatives must be registered annually 
with the Department of Internal Revenue and pay an 
annual tax of one dollar. They are permitted to sell any of 
the substances listed under the law, only upon the written 
order of a physician, pharmacist or dentist who is also 
registered with the Department of Internal Revenue. 

2. Every physician and dentist must be registered with 
the Department of Internal Revenue and pay an annual 
tax of one dollar. They must keep a record of the quantities, 
and drugs obtained, and of their disposal. These records 
are subject to inspection at any time. Prescriptions calling 
for any substance listed under the Harrison law must bear 
the physician’s name, address and registry number. They 
must also contain the patient’s name, age and address, and 
must be dated on the day they are written and signed by 
the physician ordering them. 

3. Any unauthorized person who has any of the substances 
listed under the law in his possession, is subject to a fine 
of $2,000 or five years’ imprisonment or both. 


List of Drugs under the Harrison Law 


Opium 

Opium Powder 
Opium tablets (all strengths) 
Extract of Opium 
Dover’s Powder 
Tincture of Dover’s Powder 
Tinctura Opii Simplex 
Tincture of Deodorized Opium 
Morphine Sulphate (all 
strengths and all tablets) 
Magendie’s Solution 
Codeine and its salts 
Codeine tablets (all strengths) 
Dionine (all strengths) 
Codeonal 

Heroine (all tablets and all 
strengths) 

Papaverine 

Pantopon 

Apomorphine Hydrochloride 

Stypticin 

Styptol 


Coca 

Fluidextract of Coca 
Cocaine 

Cocaine Hydrochloride 
Cocaine tablets (all strengths 
and all combinations) 
Codrenin 
Eucaine 
Holocaine 
Novocaine 
Tropacocaine 
Anesthesin 
Orthoform 


HEADACHE POWDERS 


In addition, all mixtures or prescriptions containing opium, 
coca, or their derivatives except the following: 

1. Preparations that contain less than 2 grains of opium in 
every ounce. 

2. Preparations that contain less than *4 grain of morphine, 
1 gr. of codeine, or % gr. of heroine, in every ounce. 

3. Liniments or ointments which are used externally, 
except those containing cocaine or eucaine (alpha or beta), 
or any of their salts or synthetic substances. 

Application of the Harrison Law in Hospitals 

Every hospital must be registered with the Department of 
Internal Revenue and receives a registry number and is 
subject to the same regulations as physicians. 

By the following method a record may be kept of the 
quantities used of the drugs listed under the Harrison law. 

1. Substances listed under the Harrison law must be 
ordered for ward use upon special blanks upon which appears 
the hospital registry number. All drugs listed in the Har¬ 
rison law must be ordered on one of these blanks and be 
signed by a physician. 

2. Every order calling for opium, coca, or any of their 
derivatives must be signed by the physician who orders it, 
both in the order book and on the chart. 

3. A special book should be kept in every ward, in which 
the nurse enters the name, date, journal number, the dose 
and the drug given. If a bottle containing any drug listed 
under the Harrison law is broken, a record of it should also 
be made. In this book the nurse is therefore able to 
account for the quantities of Harrison law drugs obtained 
from the pharmacist. 

HEAD, FALLS OR BLOWS ON 

Children frequently receive a blow on the head by a fall or 
other accident. If the blow is severe enough to cause uncon¬ 
sciousness, a doctor must be sent for at once. While awaiting 
his arrival, take the child into a quiet room, unfasten the 
clothing around the neck, apply ice-cloths to the head, and 
hot water bags to the legs and feet; but on no account give 
any alcoholic stimulant. If the stomach is not nauseated, a 
drink of hot milk will be reviving. 

In some severe cases days may elapse before the child 
regains consciousness, and during that period nourishment 
must be given in the form of nutritive enemata. 

HEADACHE POWDERS 


Antipyretics. 


HEAD LOUSE 


See Lice. 


HEAD LOUSE 


HEART 

The heart is a hollow, muscular organ, situated in the 
thorax between the lungs, and above the central depression 
of the diaphragm. It is about the size of the closed fist, 
shaped like a blunt cone, and so suspended by the great 
vessels that the broader end or base is directed upward, 
backward, and to the right. The pointed end or apex points 
downward, forward, and to the left. As placed in the body, 
it has a very oblique position, and the right side is almost 
in front of the left. The impulse of the heart against the 
chest wall is felt in the space between the fifth and sixth 
ribs, a little below and to the inner side of the left nipple. 

The cavities of the heart. —The heart is divided from the 
base to the apex, by a fixed partition, into a right and left 
half, frequently called right and left heart. The two sides 
of the heart have no communication with each other after 
birth. The right side always contains venous,' and the left 
side arterial, blood. Each half is subdivided into two cavities, 
the upper, called auricle; the lower, ventricle. The muscular 
walls of the auricles are much thinner than those of the 
ventricles, and the wall of the left ventricle is thicker than 
that of the right (the proportion being as 3 to 1). These 
cavities communicate with one another by means of con¬ 
stricted openings, the auriculo-ventricular orifices, which are 
strengthened by fibrous rings and protected by valves. 


Valves of the Heart 

The tricuspid valve. —The valve guarding the right auriculo- 
ventricular opening is composed of three irregular-shaped 
flaps, or cusps, and is named tricuspid. The flaps are mainly 
formed of fibrous tissue covered by endocardium. At their 
bases they are continuous with one another, and form a 
ring-shaped membrane around the margin of the auricular 
opening: their pointed ends are directed downward, and 
are attached by cords, the chordoc tendinece, to little muscular 
pillars, the papillary muscles, provided in the interior of the 
ventricles for this purpose. 

The bicuspid or mitral valve. —The valve guarding the 
left auricular opening consists of only two flaps or cusps, 
and is named the bicuspid, or mitral valve. It is attached 
in the same manner as the tricuspid valve, which it closely 
resembles in structure, except that it is much stronger and 
thicker in all its parts. 

Function. —These valves oppose no obstacle to the passage 
of the blood from the auricles into the ventricles because 


HEAT EXHAUSTION 


the free edges of the flaps are pointed in the direction of, 
the blood current; but any flow forced backward gets between 
the flaps and the wall of the ventricle, and drives the flaps 
upward, until, meeting at their edges, they unite and form a 
complete transverse partition between the ventricle and 
auricle. Being'retained by the chordae tendineae, the. expanded 
flaps of the valve resist any pressure of the blood which might 
otherwise force them to open into the auricle; at the same 
time the papillary muscles, to which the chordae tendineae 
are attached, contract and shorten and thus keep them 
taut. 

Semilunar valves. —The valves between the ventricles and 
arteries are called the semilunar valves ( aortic and pul¬ 
monary). These valves consist of three half-moon-shaped 
pockets, each pocket being attached by its convex border to 
the inside of the artery where it joins the ventricle, while 
its other border projects into the interior of the vessel. 
Small nodular bodies, called the corpora Arantii, are attached 
to the center of the free edge of each pocket. 

Function. —These valves offer no resistance to the passage 
of blood from the heart into the arteries, as the free borders 
project into the arteries, but they form a complete barrier 
to the passage of blood in the opposite direction. In this 
case each pocket becomes filled with blood, and the free 
borders are floated out and distended so that they meet in 
the center of the vessel. 

HEATSTROKE AND HEAT EXHAUSTION 
Heatstroke 

Heatstroke results from exposure of the bo^y to a high 
external temperature from any source, especially when the 
air is saturated with moisture. It differs from sunstroke in 
that the person need not be exposed to the direct rays of 
the sun. It may occur at midnight or in a close, poorly 
ventilated room. The condition is more apt to develop 
in debilitated persons or in persons engaged in hard physical 
labor, especially in those who are in the habit of drinking 
beer or whiskey, and whose clothing does not allow for 
sufficient heat elimination by the rapid evaporation of 
moisture from the skin. 

The symptoms, as described by Dr. W. G. McCallum, 
are as follows: 

“The mildest effect (heat prostration) consists in headache, 
moderate rise in temperature, pains in back and limbs, and 
extreme exhaustion. More severe is the asphyctic form, in 
which great dyspnea and cyanosis, with delirium or uncon¬ 
sciousness are added to these symptoms. Still more severe. 


HEATSTROKE 


and frequently fatal, is the hyperpyretic type, in which 
unconsciousness and collapse come on suddenly, or after 
several days of vague premonitory symptoms. There are 
convulsions, delirium, or profound coma with shallow and 
gasping or very deep respiration, and finally failure and 
stoppage of the heart. The skin, at first covered with sweat, 
becomes hot and dry, and the temperature rises to phenomenal 
levels.” Cases are reported having a temperature of xo8° 
to ii2° F. and even as high as 117.6° F. 

The treatment consists in lowering the body temperature 
by increasing heat elimination and preventing further heat 
production. 

The patient should be removed to a quiet, cool place and 
placed in bed in the recumbent position as soon as possible. 
His head should be slightly elevated. His clothing should 
be loosened and entirely removed. Cold applications should 
be applied continuously to the head and neck, in the form 
of compresses or an ice-bag, etc., and to the entire body in 
the form of cold sponges, affusions, baths or packs. Brisk 
rubbing should be applied so as to bring the hot blood to 
the skin. Cool enemata may also be given. The treatments 
are continued until the temperature drops to 101° F., after 
which the patient lies quietly in bed, covered with a sheet 
only. In giving the treatments, care is taken not to cause 
the temperature to fall below normal and cause collapse. 
The pulse must be closely watched throughout for symptoms 
of collapse. 

When the cold applications are removed, the patient’s 
temperature must be watched constantly as it is likely to 
rise again rapidly and the treatments will have to be resumed. 

Even after, the temperature has been permanently reduced, 
the patient requires extreme care on account of the danger 
of cerebral congestion, meningitis and secondary changes 
and impairment of the functions of the brain which may 
follow. An ice-cap should be kept on the head. Rest, quiet, 
fresh air, and careful regulation of the diet and body 
eliminations are essential. 

Exposure to the sun or any form of heat should in future 
be avoided as one attack predisposes to another. 

Heat Exhaustion 

Heat Exhaustion differs from the above, in that, while it 
may be produced by the same conditions, the result or effect 
on the patient is different. 

The symptoms are those of collapse—a subnormal tempera¬ 
ture usually, a pale, cool, moist skin, a weak, rapid pulse, 
marked weakness or extreme prostration. As a rule, the 
patient does not lose consciousness although syncope may 


HEIGHT AND WEIGHT TABLES 


occur. There may be restlessness and, in severe cases, 
delirium. 

The treatment is directed toward raising the body tempera¬ 
ture and in treating for collapse. The patient should be 
placed in the recumbent position with the head low; the 
clothing should be loosened, fresh air freely admitted, and 
external heat applied in the form of hot blankets, hot-water 
bottles, a hot bath or pack, and a hot enema. Hot tea or 
coffee may be given to drink and cardiac stimulants such as 
aromatic spirits of ammonia, caffeine or strychnine. The body 
temperature must be watched closely in order to avoid an 
elevation above normal as a result of the hot applications. 

Rest and quiet are essential until the patient is fully 
recovered. 


HEDONAL 

Hedonal is a white, crystalline powder with a cooling effect 
in the mouth, like that of menthol. It produces sleep in 
about half an hour after it is given. It is a comparatively 
safe drug and produces no after-effects. It occasionally 
increases the flow of urine. It is given in powders or 
tablets; dose 30 grains. 

HEIGHT AND WEIGHT TABLES 

Heights and Weights for Children Under Five Years of 

Age 

(Based on Data Published by the Children’s Bureau, U. S. 
Department of Labor) 


Age, 

Months 

BOYS 

GIRLS 

Height, 

Inches 

Weight, 

Pounds 

Height, 

Inches 

Weight, 

Pounds 

Birth. 

20.6 

7.6 

20.5 

7.2 

3 

23 5 

13 0 



6 . 

26.5 

18.0 

25.9 

16.8 

9. 

28.1 

20.4 

26.6 

19.1 

12 . 

29.4 

21.9 

28.9 

20.8 

15. 

30.8 

23.6 

30.1 

21.9 

18. 

31.8 

24.6 

31.1 

23.4 

21 . 

32.9 

25.8 

32.3 

24.8 

24. 

33.8 

27.1 

33.4 

26.4 

27. 

34.8 

29.0 

33.9 

27.3 

30. 

35.4 

29.5 

34.9 

28.3 

33. 

36.1 

30.6 

35.6 

29.1 

36. 

37.1 

32.3 

36.8 

30.5 

39. 

37.9 

33.1 

37.3 

31.6 

42. 

38.6 

33.8 

38.0 

32.5 

45. 

39.0 

34.5 

38.5 

33.3 

48. 

39.5 

35.9 

39.0 

33.8 

60. 

41.6 

41.1 

41.3 

39.7 






































HEMATEMESIS 


Height and Weight Table for Boys 


Height 

Inches 

«/) 

Vh 

I* 

Id 

6 Yrs. 

7 Yrs. 

8 Yrs. 

9 Yrs. 

10 Yrs 

11 Yrs 

12 Yrs 

I 13 Yrs 

| 14 Yrs 

15 Yrs 

16 Yrs 

17 Yrs 

18 Yr: 


35 

36 

37 












40 

37 

38 

39 












41 

39 

40 

41 












49 

41 

42 

43 

44 











43 

43 

44 

45 

46 











44 

45 

46 

46 

47 












47 

47 

48 

48 

49 











48 

49 

50 

50 

51 










47 

51 

52 

52 

53 

54 









4ft 


53 

54 

55 

55 

56 

57 








4Q 


55 

56 

57 

58 

58 

59 








50 


58 

59 

60 

60 

61 

62 







51 



60 

61 

62 

63 

64 

65 







52 



62 

63 

64 

65 

67 

68 







53 



66 

67 

68 

69 

70 

71 






54 




69 

70 

71 

72 

73 

74 






55 




73 

74 

75 

76 

77 

78 





56 





77 

78 

79 

80 

81 

82 





57 






81 

82 

83 

84 

85 

86 




58 






84 

85 

86 

87 

88 

90 

91 



59 






87 

88 

89 

90 

92 

94 

96 

97 


60 






91 

92 

93 

94 

97 

99 

101 

102 


61 







95 

97 

99 

102 

104 

106 

108 

no 

62 







100 

102 

104 

106 

109 

111 

113 

116 

63 







105 

107 

109 

111 

114 

115 

117 

119 

64 








113 

115 

117 

118 

119 

120 

122 

65 









120 

122 

123 

124 

125 

126 

66 









125 

126 

127 

128 

129 

130 

67 









130 

130 

132 

133 

134 

135 

68 









134 

135 

136 

137 

138 

139 

69 









138 

139 

140 

141 

142 

143 

70 










142 

144 

145 

146 

147 

71 










147 

149 

150 

151 

152 

72 










152 

154 

155 

156 

157 

73 










157 

159 

160 

161 

162 

74 










162 

164 

165 

166 

167 

75 











169 

170 

171 

172 

76 











174 

175 

176 

177 


Prepared by Dr. Thomas D. Wood 

Courtesy of Child Health Organization of America 


HEMATEMESIS 

Hematemesis, Gastrorrhagia, or Bleeding from the 
Stomach.— The vomiting of blood is not always a sign of 
bleeding from the stomach, because blood from the nose, 
throat, or lungs may be swallowed and vomited later. 

Causes of Hematemesis: 

i. Local.— (a) Cancer, ulcer, diseases of the blood-vessels 
(miliary aneurysms and varicose veins), acute congestion, 
and following operations on the abdomen. 

(b) Passive congestion, due to obstruction of the portal 















































































HEMATEMESIS 


Height and Weight Table for Girls 


1 Height 
1 Inches 

5 Yrs. 

6 Yrs. 

7 Yrs. 

8 Yrs. 

9 Yrs. 

10 Yrs. 

11 Yrs. 

12 Yrs. 

13 Yrs. 

14 Yrs. 

15 Yrs. 

16 Yrs. 

17 Yrs. 

18 Yrs. 

39 

34 

35 

36 












40 

36 

37 

38 












41 

38 

39 

40 












42 

40 

41 

42 

43 











43 

42 

42 

43 

44 











44 

44 

45 

45 

46 











45 

46 

47 

47 

48 

49 










46 

48 

48 

49 

50 

51 










47 


49 

50 

51 

52 

53 









48 


51 

52 

53 

54 

55 

56 








49 


53 

54 

55 

56 

57 

58 








50 



56 

57 

58 

59 

60 

61 







51 



59 

60 

61 

62 

63 

64 







52 



62 

63 

64 

65 

66 

67 







53 




66 

67 

68 

68 

69 

70 






54 




68 

69 

70 

71 

72 

73 






55 





72 

73 

74 

75 

76 

77 





56 





76 

77 

78 

79 

80 

81 





57 






81 

82 

83 

84 

85 

86 




58 






85 

86 

87 

88 

89 

90 

91 



59 






89 

90 

91 

93 

94 

95 

96 

98 


60 






94 

95 

97 

99 

100 

102 

104 

106 

61 







99 

101 

102 

104 

106 

108 

109 

111 

62 







104 

106 

107 

109 

111 

113 

114 

115 

63 







109 

111 

112 

113 

115 

117 

118 

119 

64 








115 

117 

118 

119 

120 

121 

122 

65 








117 

119 

120 

122 

123 

124 

125 

66 








119 

121 

122 

124 

126 

127 

128 

67 









124 

126 

127 

128 

129 

130 

68 









126 

128 

130 

132 

133 

134 

69 









129 

131 

133 

135 

136 

137 

70 










134 

136 

138 

139 

140 

71 










138 

140 

142 

143 

144 

72 











145 

147 

148 

149 


Prepared by Dr. Thomas D. Wood. 

Courtesy of Child Health Organization of America. 


system as in cirrhosis of the liver, thrombus in the portal 
vein, an enlarged spleen, pressure on the portal vein from 
without by tumors. 

(c) Traumatism—wounds, corrosive poisons, etc. 

2 . Constitutional.—Hemophilia and severe anemia. 

Treatment. —The patient must be put to bed in the re¬ 
cumbent position and kept absolutely quiet. Morphine is 
usually given to put the patient and the stomach absolutely 
at rest, and to aid in the formation of a clot. Nothing 
should be given by mouth except small quantities of cracked 
ice. Astringents such as adrenalin, or tannic acid are 
occasionally given by mouth. Cold compresses, an ice-bag 
or the ice-coil should be applied to the epigastrium. Ergotin 






































































HEMOPTYSIS 


is sometimes given hypodermically. No stimulants are given 
because of the danger of increasing the hemorrhage. 

When the loss of blood has been great, syncope may result 
and must be treated. A direct transfusion may be given 
or an infusion of normal saline solution. The extremities 
may be bandaged toward the heart. The later treatment 
consists in tonics and a carefully regulated diet. 

See Hemoptysis, and Stomach. 

HEMOPTYSIS 

Hemoptysis—the Coughing or Spitting of Blood 

Causes.—i. Pulmonary tuberculosis, from rupture of a 

blood-vessel. 

2 . Diseases of the lungs—pneumonia, cancer, abscess, gan¬ 
grene, etc., and ulceration of the bronchi, trachea, or larynx. 

3 . Certain diseases of the heart, particularly mitral lesions 
which cause a damming back of blood in the left auricle, 
next into the pulmonary vessels, causing marked pulmonary 
congestion. 

4 . Aneurysm and erosion of a large blood vessel, which may 
cause a fatal hemorrhage. 

The following table, taken from Osier, differentiates be¬ 
tween hemoptysis and hematemesis: 


HEMATEMESIS 

Previous history points to 
gastric, hepatic, or splenic 
disease. 

The blood is brought up 
by vomiting, prior to which 
the patient may experience 
a feeling of giddiness or 
faintness. 

The blood is usually 
clotted, mixed with particles 
of food, and has an acid 
reaction. It may be dark, 
grumous, and fluid. 

Subsequent to the attack 
the patient passes tarry 
stools, and signs of disease 
of the abdominal viscera 
may be detected. 


HEMOPTYSIS 

Cough or signs of some 
pulmonary or cardiac dis¬ 
ease precedes, in many 
cases, the hemorrhage. 

The blood is coughed up, 
and is usually preceded by 
a sensation of tickling in 
the throat. If vomiting 
occurs, it follows the cough¬ 
ing. 

The blood is frothy, 
bright red in color, alkaline 
in reaction. If clotted, 
rarely in such large coagu- 
la, and muco-pus may be 
mixed with it. 

The cough persists, physi¬ 
cal signs of local disease 
in the chest may usually 
be detected and the sputa 
may be blood-stained for 
many days. 








HEMORRHAGE 


Treatment. —Complete rest in bed and absolute quiet are 
essential. The patient is usually very much alarmed and 
very much depressed. He should be reassured, his mind and 
body both put at rest. Death is rarely due to hemoptysis 
from a congested lung. (Osier.) Morphine is usually given 
to quiet the patient. To lessen the heart-beats and lower 
the blood-pressure, a hypodermic of nitroglycerine, i/ioo grain, 
or an inhalation of amyl nitrite (5 minims) is frequently 
ordered. 

The patient should be turned on the affected side, if 
known, as the blood is then less apt to enter the unaffected 
lung. However, if the patient wants to sit up and can breathe 
better and is less anxious or alarmed when sitting up, it is 
better to allow him to do so. To lessen the nervous excite¬ 
ment and the distressing cough, chloral and bromides are fre¬ 
quently given by mouth or by rectum. No stimulants should 
be given or allowed in the food or drink. Ice may be given 
to suck. 

An ice-bag is sometimes applied over the sternum or over 
the part where the bleeding is thought to be. 

When the hemorrhage continues, salts are sometimes given 
to cause purging in order to lower the blood-pressure. When 
the hemorrhage is very severe, the head must be lowered to 
keep the blood in the vital parts. The extremities may be 
bandaged. 

When food is permitted, it should be very light. 

HEMORRHAGE 

Hemorrhage is the escape of blood from the vessels which 
occurs as the result of trauma, or disease. 

Varieties of Hemorrhage 

I. According to Time: 

(a) A primary hemorrhage is one which occurs at the 
time of the injury. 

(b) An intermediate or recurrent hemorrhage is one which 
occurs in from 12 to 48 hours after. 

(c) A secondary hemorrhage is one which occurs after a 
few days—from two days up to the time of complete 
healing. 

II. According to the Cause: 

(a) Trauma. 

1 . An external hemorrhage is one in which the blood escapes 
from the skin or soft parts. 

2 . An internal or concealed hemorrhage is one in which 
the blood escapes into a body cavity. Examples would be a 
hemorrhage into the pelvic cavity in injury to the pelvic 
viscera or in rupture of the Fallopian tubes; a hemorrhage 


HEMORRHAGE 


into the stomach; hemothorax, and bleeding into the perito 
neal cavity in typhoid fever. 

3. A subcutaneous hemorrhage is one in which the bleed¬ 
ing is into the soft tissues beneath the unbroken skin. 

Examples of subcutaneous hemorrhage are a false aneurysm, 
that is, an extensive hemorrhage from an artery into the 

subcutaneous tissue forming a pulsating tumor; a hematoma, 
that is, an extensive hemorrhage from a vein forming a 

tumor which does not pulsate; a contusion or bruise in which 
bleeding occurs from many small blood-vessels; ecchymoses or 
“black and blue marks” are hemorrhages too small to form 
a tumor. 

(b) Disease. 

1. In scurvy—bleeding from the gums. 

2. In typhoid—bleeding from ulcers in the intestines. 

3. Epistaxis—bleeding from the nose due to ulceration or 
congestion of the mucous membranes. 

4. Hemoptysis—bleeding from the lungs in tuberculosis. 

5. Hematemesis—bleeding from the stomach in ulcers or 
carcinoma, etc. 

6. Melena—bleeding from the intestines from ulceration, 
congestion, or new growths. 

7. Hematuria—bleeding from the urinary tract in diseases 
of the kidneys, ureters, bladder, prostate, or urethra, and 
from calculi or new growths. 

8. Cerebral hemorrhage (apoplexy)—hemorrhage in the 
brain from disease of the blood-vessels. 

9. Purpura and petechiae are very small hemorrhages (pete- 
chiae are pin points) into the skin and mucous membranes 
which do not disappear on pressure. They occur in infec¬ 
tious diseases—measles, scarlet fever, small-pox, typhus fever, 
in pyemia, septicemia, and leukemia and in purpura haernor- 
rhagica in which there may also be epistaxis, hematuria, etc. 

10. Hemophilia is an hereditary disease which occurs almost 
exclusively in men, but is transmitted along the female line, 
that is, from mother to son. Men suffering from this 
disease are called bleeders. Their blood fails to clot so that 
bleeding from a slight wound or from the extraction of a 
tooth may be impossible to control and the patient may 
bleed to death. The treatment is administration of calcium 
lactate which aids the clotting of the blood. 

III. According to the Source: 

(a) Arterial hemorrhage or bleeding from an artery is most 
dangerous because difficult to control. It may be recognized 
by (1) the bright red color; (2) the blood escapes in spurts 
occurring with the heart beat or pulse; (3) in an extremity 
the pulse below may be obliterated and pressure above the 
wound (between it and the heart) controls it. 


HEMORRHAGE 


(b) Venous hemorrhage or bleeding from a vein. The 
blood is darker in color, due to the loss of oxygen. It 
flows steadily and bleeding is easily controlled. 

(c) Capillary hemorrhage in which there is a general oozing 
of blood from the surface. It neither spurts nor flows 
steadily, but wells up in the wound and the surface seems 
to “weep.” In a deep wound the blood trickles down over 
the surface and gradually fills it up from the bottom. 

Hemorrhage may occur from all three sources together. 

Local Treatment of Hemorrhage 

Hemorrhage may be controlled by (i) pressure; (2) posi¬ 
tion; (3) extreme heat or cold; (4) astringents or styptics; 
(5) ligation; (6) torsion; (7) sutures; (8) the cautery. 

Pressure may be made with the fingers (digital pressure), 
a tourniquet, compresses or packing and a tight bandage. 
The bleeding must be controlled by whatever means lies in 
one’s power in order to prevent the patient from bleeding 
to death. Pressure with the fingers along the course of the 
bleeding vessel will control a hemorrhage temporarily even 
from a large vessel. Bleeding from the forearm can only 
be checked by pressure on the vessels in front of the elbow 
or on the brachial artery. 

In bleeding from an artery, pressure must be made above 
the wound, that is, between it and the heart. In bleeding 
from a vein digital pressure must be made below the bleeding 
point, that is, between it and the periphery. Also all tight 
constricting bands (tight clothing or elastic garters, etc.) 
between the bleeding point and the heart must be removed 

to allow the blood to return by the deep veins. 

The Tourniquet .—Fingers soon tire, so other means must be 
substituted. One of the most successful means of controlling 
bleeding from a large artery in an extremity is by applying 
a tourniquet above the bleeding point. The specially con¬ 
structed tourniquets are made either of elastic rubber or of 

heavily braided material as in the army tourniquet. Im¬ 

provised tourniquets may be used—rubber tubing, a folded 
handkerchief, a necktie, a leather strap, etc. In all cases 
the tourniquet must be wide enough not to cut the skin 
and pressure must never be made on nerve trunks. A hard, 
firm compress is placed over the line of the artery (where 
digital pressure is made) and the tourniquet is tightened 
around it. It must be applied tightly enough to control 
the hemorrhage, if necessary tightly enough to obliterate 
the pulse. It is never left on longer than necessary because 
prolonged pressure causes severe pain and may cause severe 
injury to the tissues and nerves and may even cause gan¬ 
grene. It must be left on, however, until the services of a 


HEMORRHAGE 


surgeon are secured, which should be done as soon as pos¬ 
sible. If this cannot be done within an hour usually a 
clot has sufficiently formed to allow the tourniquet to be 
loosened (but not removed) after a dressing and tight 
bandage have been applied to the wound. 

Sterile gauze packing in the wound or sterile com¬ 
presses held by a tight bandage will usually control hemor¬ 
rhage from a vein or capillaries. 

Position. —Elevation of an extremity is one of the simplest 
and most quickly applied remedies. Elevation alone or com¬ 
bined with other temporary remedies is usually successful 
and may save the life of a patient. Hyperflexion at the 
elbow or knee joints, that is, placing a pad in the bend and 
flexing the forearm against the upper arm or the lower leg 
against the thigh and maintaining the position with a tight 
bandage, will usually control hemorrhage from an artery 
in the forearm or leg. This combines position and pressure. 
The head, or the head of the bed, is elevated in epistaxis 
or cerebral hemorrhage. The foot of the bed,, or the but¬ 
tocks, is elevated in bleeding from the pelvis, etc. 

The application of heat or cold will often check venous or 
capillary hemorrhages. When hot water is used it must be 
very hot, 120 ° to 140 ° F., to contract the blood vessels, as 
warm water causes further dilatation and bleeding. Heat 
also hastens clotting by coagulating the albumin of the blood 
and tissues. A hot vaginal or intra-uterine douche is one of 
the methods used to control bleeding from the uterus. 

An ice-bag or ice compresses will often check capillary hem¬ 
orrhages and will give great relief, check bleeding and 
prevent discoloration (black and blue marks) in subcutaneous 
hemorrhages such as contusions. The prolonged use of ice, 
however, may be dangerous, as it checks the circulation, lessens 
the supply of healing blood to the part and may cause gan¬ 
grene, especially in extensive bruises or in devitalized tissues. 
Children and old people do not stand cold well for extensive 
periods. 

Astringents and Styptics. —Adrenalin checks bleeding by 
contracting the arteries. It is used both internally and 
externally. The vegetable and metallic astringents such as 
alum, tannic acid, acetic acid, silver nitrate, ferric chloride 
and ferric sulphate, etc., are sometimes used to check capil¬ 
lary bleeding. Acetic acid is often added to a hot douche. 

Ligation is exposing the bleeding vessel and tying a liga¬ 
ture around it. 

Torsion is arresting hemorrhage by twisting the divided 
end of an artery which causes rupture and inversion of its 
inner coats. 


HEMORRHOIDS 


Suturing is arresting hemorrhage by suturing wounds in 
large vessels too large to be closed by ligature. 

The cautery is used to check bleeding from the cut surface 
of bone, of inflammatory tissue and in surgical operations such 
as hemorrhoids. 

Systemic Treatment of Hemorrhage 

If the injury has been severe the patient will suffer from 
shock. If a considerable amount of blood has been lost he 
will suffer from this loss also and the effect and treatment 
will be much the same. Even while controlling the hemor¬ 
rhage the treatment for shock should be remembered and 
begun at once. The patient should be kept quiet, in the 
recumbent position, the clothing about the chest loosened 
and the body warmth increased. 

For the loss of blood the patient should have absolute 

quiet and rest in bed to lessen the work of the heart and 

the demands of the tissues. The head should be lowered, 
the trunk and extremities elevated to cause more blood to 
gravitate to the brain to supply the vital centers. To give 

the heart more blood to pump and keep blood where it is 

vitally needed, the limbs may be temporarily deprived of 
blood by elevating them and bandaging from the fingers 
and toes toward the heart. To increase the volume of 
blood direct transfusions or infusions of normal saline 
solution may be given. Heat may be applied to the extremi¬ 
ties and hot fluids by mouth or by rectum may be given. 
Later, to aid nature repair the loss, rest, fresh air, sunlight, 
nutritious food and tonics (iron and arsenic) to increase the 
hemoglobin and stimulate the blood-forming organs are 
valuable. 

See Shock. 


HEMORRHOIDS 

Hemorrhoids or Piles are simply dilated veins about the 
rectum. They are divided into the internal variety (those 
situated above the internal sphincter), and the external 
variety (beneath the external sphincter). Piles may be a 
source of annoyance by their protrusion, their bleeding, or 
the veins may become inflamed and thrombosed. 

Ante-operative Treatment. —The treatment does not differ 
from that of an ischio-rectal abscess. 

Operative Treatment. —After the patient .is anesthetized, 
the sphincter ani is dilated manually as a preliminary step 
to the operation. This gives a better exposure of the interior 
of the rectum, and by paralyzing the sphincter, the after 
pain is less, since the muscle about the rectum cannot contract. 

The piles are removed by (i) simple excision, ( 2 ) clamp 


HEMORRHOIDS 


and cautery, or ( 3 ) by ligating the pile-bearing area. After 
the operation has been performed, some surgeons insert a 
rectal tube around which has been wrapped two or three 
layers of vaselinated iodoform gauze. The advantages of 
this are twofold: it prevents hemorrhage and it enables the 
accumulated gas to escape; but it has the great disadvantage 
of being rather painful and uncomfortable for the patient. 

Post-operative Treatment. —The same measures are taken 
as for an ischio-rectal abscess, except that on the fourth 
day, when the cathartic is given, immediately before the 
patient moves the bowels, six ounces of warm olive oil are 



# 

4 


Tube “en chemise.” A. layer of gauze attached to rubber 

tube B. 

(From Colp and Keller’s Textbook of Surgical Nursing) 

introduced into the rectum through a tube. This softens 
the accumulated feces and lubricates their passage. Fol¬ 
lowing the movement of the bowels, the patient should be 
instructed to take Sitz baths, night and morning. These are 
comforting and are very helpful in healing the denuded areas 
about the rectum. For a period of two to three weeks after 








HERNIA 


operation, the patient should receive nightly an ounce of 
licorice powder, as it is essential that the bowels be kept 
soft and loose. The patient should be put on an anti¬ 
constipation diet. (See Constipation.) 

Complications. —The great danger in a hemorrhoid opera¬ 
tion is that of hemorrhage. If a patient begins to faint 
and to show the signs of hemorrhage, even though no 
blood is visible externally, which might happen if a rectal 
tube is not inserted, the attending surgeon should be imme¬ 
diately summoned. The patient is placed under anesthesia, 
a tube “en chemise” is introduced and the rectum firmly 
packed. A tube “en chemise” is simply a rubber tube to 
the rectal end of which gauze is attached. It is inserted 
into the rectum and packing is introduced between the tube 
and gauze, thereby exerting pressure on the bleeding area. 
Sometimes the bleeding point itself may be ligated. 

See Constipation, Ischio-rectal Abscess. 

HERNIA 

A hernia, or rupture, may be defined as “the protrusion 
of an organ or part of an organ or other structure through 
the wall of the cavity normally containing it.” The rupture 
is named from the region in which it appears. There are 
many locations where, because of certain mechanical weak¬ 
nesses, hernia is quite common. It occurs very frequently 
in the inguinal region. 

Inguinal hernia is a form of rupture that occupies the 
inguinal canal either partly or entirely. 

Under ordinary conditions, the contents of the hernial 
sac will disappear into the abdominal cavity when the indi¬ 
vidual is at rest, to reappear when the intra-abdominal pres¬ 
sure is increased, as during coughing or arduous physical 
labors. A hernia which disappears is known as reducible; 
if, because of adhesions, this cannot occur it is irreducible. 
There are several varieties of the irreducible group: Incar¬ 
cerated ,—a type of obstructed hernia containing bowel in 
which the passage of fecal material is arrested but the circu¬ 
lation of the intestine is unimpaired. Strangulated ,—a 
hernia in which not only the bowel is obstructed but also 
the blood supply. If this condition is not operated upon 
very soon after its incipiency a gangrene of the obstructed 
loops of intestine will result. 

Other varieties of hernia are femoral, which is a rupture 
in the region of Scarpa’s triangle occurring through the 
femoral ring; umbilical, which is a protrusion through the 
abdominal wall in the region of the umbilicus. Then there 
are hernias which occur following operation, especially in 


HEROINE 


those cases in which the abdominal wall has become weakened. 
These are known as post-operative hernias. 

Ante-operative Treatment. —The same ante-operative rou¬ 
tine is employed as for all chronic cases. The lower abdomen 
and genitals are shaved and a sterile dressing is applied. 
Care must be taken that the external genitalia are not 
painted with iodine. In the operating room, the operative 
field is repainted with iodine, and the penis and scrotum 
are enclosed in a sterile, wet bichloride towel. 

Post-operative Treatment. —As soon as the patient reaches 
the ward, a pillow is placed under the knees, and as soon 
as he is conscious, a Bellevue bridge is applied across the 
thighs to support the scrotum. 

The cathartic is given on the second day and, as a rule, 
patients are kept in bed for two or more weeks. For the 
first twenty-four hours catheterization may be necessary. 

In cases of incarcerated and strangulated hernias after 
the sac has been opened, the surgeon will cover the bowels 
with moist warm saline towels for about ten minutes, and 
if there is no evidence of real damage, and their color is 
good, the intestines are reduced into the peritoneal cavity. 
If the intestines are gangrenous, an intestinal resection will 
have to be done. These cases are then treated like any 
other case of intestinal resection. 

In all cases of hernia it is very important to impress upon 
the mind of the patients who have been recently operated 
on that for a few months, at least, all physical exercise 
should be of the mildest kind, and that any sudden strain 
must be avoided. 


HEROINE 

Heroine is an artificial alkaloid made from morphine by 
its combination with an organic salt of acetic acid (diacetyl 
morphine hydrochloride). Its effects are similar to those 
of morphine with the following differences: 

1. It makes the breathing slower than morphine does. 

2. It is used principally to lessen coughing. It does not 
produce sleep as easily. 

Recently the heroine habit has become very common, 
because of the difficulty in obtaining morphine. The heroine 
is usually taken by snuffing heroine powder up into the 
nose. The symptoms are like those of the morphine habit. 

See Morphine, and Opium. 

Preparations 

Heroine; dose V&4 to % of a grain. 

Heroine Hydrochloride; dose V24 to of a grain. 


HOPS 


HEXAMETHYLENAMINE (URGTROPIN) 

Hexamethylenamine or Urotropin is an artificial chemical 
substance which is used principally as a urinary antiseptic. 

Hexamethylenamine liberates formaldehyde in the urine. 
This disinfects the urine and the mucous membranes of the 
genito-urinary tract with which it comes in contact. It 
only acts when the urine is acid. 

It has also been used in various septic conditions because 
of the formaldehyde gas which it liberates in the blood and 
secretions. It has frequently been injected into the spinal 
canal for meningitis. 

Large doses occasionally cause burning pain in the stomach, 
pain on urination, and the urine occasionally contains blood. 
Dose of hexamethylenamine is 3 to 10 grains. 

HICCOUGH 

Hiccough can often be stopped by making the person 
sneeze half a dozen times, or letting him sip water and 
hold his breath as long as possible between each sip. An¬ 
other method is to pour vinegar on a lump of sugar and 
let him swallow it whole. 

HOFFMAN’S ANODYNE 

See Compound Spirits of Ether. 

HOLAZONE 

Holazone is a complex organic chlorine compound. It 
acts like Dakin’s solution but it does not decompose readily. 
It is used in tablets of 0.004 to 0.008 gm. together with 
sodium borate and sodium chloride. Each tablet is dissolved 
in a liter of water. 

See Dakin’s Solution. 

HOLOCAINE 

Holocaine is an artificial alkaloid made from phenacetin. 
Its effects are similar to those of cocaine, but they appear 
sooner. It is also an antiseptic. It occasionally causes 
poisonous symptoms. 

Preparation 

Holocaine Hydrochloride. It is principally used in a 
1 per cent, solution as a local anesthetic in the eye. 

And see Cocaine. 


HOMATROPINE 

See Belladonna. 


See Humulus. 


HOPS 


HOT-AIR BATH 


HOT-AIR BATH 

This consists in the exposure of the entire body, with 
the exception of the head, to a superheated atmosphere. 

Conditions in which the Hot-Air Bath is Commonly 
Used: —i. In nephritis, to stimulate the skin and induce 
perspiration as a means of elimination. 

2. In chronic rheumatism, to raise the body temperature 
and cause increased oxidation and elimination of proteid 
wastes. 

3. In obesity, to cause increased oxidation of fats. 

4. In sciatica and lumbago, to relieve pain and relax 
muscles. 

5. As a preparation for general cold applications. 

It is Contraindicated: 

1. In eruptive skin diseases. 

2. In febrile conditions. 

3. In arteriosclerosis and advanced cardiac or nephritic 
diseases. 

Effects Produced by Hot-Air Baths.—The effects are 
similar to those produced by the local hot-air bath, but are 
general. The temperature of the blood will be higher and 
perspiration more general and profuse. It is important to 
remember that, before perspiration begins and the surface 
vessels dilate, there may be marked cerebral congestion with 
headache, nausea and vertigo, a rapid pulse and short, difficult 
respirations. The pulse should be watched carefully and the 
patient should be watched for symptoms of excitement and 
restlessness. 

The above distressing symptoms may be prevented by 
applying cold to the head before the bath, by vigorous fric¬ 
tion of the skin to hasten the dilatation of the surface 
vessels and by raising the temperature of the bath slowly 
until perspiration begins. Perspiration may be encouraged 
by making the patient drink a glass of water before the bath 
and encouraging him to drink one or two glasses during the 
treatment. Of course this rule does not apply in dropsical 
cases when the patient is on restricted fluids. 

Method of Procedure .—Preparation of the Patient .—In a 
oroperly constructed cabinet, the patient, undressed, sits on a 
stool with the entire body enclosed except the head. The 
pulse should be taken before the bath, and, if allowed, a 
glass of water should be given. The face and neck should 
De bathed with cold water and cold applications should be 
applied to the head. 

During the bath the patient should never be left alone. 
The pulse should be taken every few minutes. Fluids 
should be given if allowed and cold compresses kept on the 


HOT PACK 


head continuously. If there is a tendency toward cerebral 
congestion, a towel saturated with cold water may be 
applied around the neck. The applications must not be cold 
enough to check perspiration. 

The temperature of the air is gradually raised to the 
desired degree in order to allow for the adjustment of the 
circulation in the viscera, otherwise anemia of the brain 
might cause the patient to faint. The desired temperature 
varies from 120° to 200° F. 

The duration of the bath varies from twenty to thirty 
minutes. 

Removal from the hath. —During removal of the patient 
avoid exposure, and chilling. In rheumatism, cardiac and 
Bright’s disease, chilling is particularly to be avoided. The 
patient should be wrapped in a warm blanket and allowed 
to cool off gradually until the skin is cool and the pulse 
normal. 


HOT PACK 

This consists in wrapping the body of the patient in a 
blanket wrung out of water as hot as can be endured by 
the patient without pain or injury. 

The effects of a hot pack are essentially the same as those 
of the vapor bath. 

1. It communicates heat to the body, prevents heat elimi¬ 
nation, raises the body temperature and induces perspira¬ 
tion. It increases the elimination of proteid ashes as the 
odor of urine on the blankets in some cases testifies. In 
this way it rests the kidneys. 

2. It is highly exciting, increases the pulse rate and 
may cause congestion of the viscera, especially of the brain. 

3. As in all hot applications, it is followed by an atonic 
reaction so that the blood vessels are relaxed and dilated and 
the arterial tension is lowered. Frequent treatments weaken 
the circulation, lower the resistance and depress all the vital 
activities. 

Conditions in which a Hot Pack is most Commonly Used:— 

The treatment is not usually ordered more frequently 
than is necessary because of its depressing effects, but may 
be ordered in any disease accompanied by symptoms of 
suppression. These are acute Bright’s disease, uremic poison¬ 
ing, bichloride of mercury poisoning, cardionephritis, and 
in the albuminuria of pregnancy and eclampsia. 

The results desired are to induce perspiration, to relieve 
edema, to eliminate waste products not eliminated by the 
kidneys and to lower arterial tension. 

Method of Procedure. —There should be two people, if 
possible, to give this treatment in order that it may be 


HOT PACK 


given as quickly and skilfully as possible without exposing 
or tiring the patient. 

Preparation of the Patient. —The bed is usually protected 
by a large rubber covered with a dry blanket. The patient 
is covered with a second dry blanket and the upper bed¬ 
clothes are turned down. The patient’s gown is removed so 
that he lies between dry blankets. Cold applications are made 
to the head, water is given to drink, if allowed, and the 
pulse is taken. 

The method of applying the wet blanket and the tempera¬ 
ture of the water in which it is wrung differ in different 
hospitals. Sometimes, to avoid burning the patient, a dry 
blanket is first wrapped around the body and limbs, the 
wet blanket not being allowed to come in contact with 
the skin. The blanket is then wrung out of boiling 
water. In other hospitals the hot wet blanket is applied 
directly to the patient’s skin. The blanket in this case will 
be wrung out of water at 150° F., that is, as hot as the 
patient can comfortably stand. Whatever method is used 
every precaution must be taken to avoid burning the patient. 
The blankets must be wrung as dry as possible. They should 
be kept hot while being carried to the bedside and applied 
at the right temperature. Special care must be taken to 
avoid burning the patient when the tissues are edematous. 
The wet blanket should be wrapped snugly around the 
patient in close contact with the whole body surface and 
so that no two surfaces of skin are in contact. If hot-water 
bags are used to maintain the heat they must never be 
allowed to come in contact with the wet blanket, but must 
be placed outside the dry blankets to prevent scalding the 
patient. The dry blankets and rubber are also wrapped 
snugly around the patient, particularly at the neck. A towel 
should be placed between the blankets and the face and 
neck of the patient. All blankets must be smooth and com¬ 
fortable when applied, with no wrinkles or bulky places 
especially under the patient. The upper bedclothes are 
replaced during the treatment. 

During the treatment the pulse should be watched care¬ 
fully. Fluids should be given to drink if allowed, and cold 
should be applied to the head continuously. 

Duration of the Pack. —The patient is usually left in the 
wet blanket for twenty minutes, unless symptoms arising 
prevent. After the removal of the wet blanket the patient 
is usually left wrapped in the dry blanket for from one-half 
to one hour. 

Before the removal of the dry blanket the patient should 
be dried carefully with a heated towel and may be rubbed 
with warm alcohol but not vigorously enough to cause con- 


HOT-WATER BAG 


tinued perspiration. A warm gown is then applied. The 
blanket is removed; the bedclothes are rearranged and the 
patient is made comfortable. There should be no exposure 
throughout the whole procedure. Some doctors require the 
patient’s temperature to be taken before, during and after 
the treatment. 

HOT-TUB BATH 

Conditions in which the Hot-Tub Bath is most Com¬ 
monly Used: —i. In dropsy due to cardiac disease, if cya¬ 
nosis is not present. 

2. In dropsy due to acute nephritis following scarlet fever 
or diphtheria. 

3. In colds to abort or break up a cold. 

4. In threatened uremic convulsions to abort an attack. 

5. In infantile convulsions and in asphyxia of the new-born. 

6. In gall stones, gastric, intestinal or renal colic and in 
cystitis to relieve pain. 

7. In suppressed menstruation. 

8. In chronic or muscular rheumatism and obesity. 

9. In icterus or jaundice, to relieve the itching and aid 
in the elimination of the bile-pigments from the tissues. 

10. In the beginning of measles or scarlet fever to 
encourage the development of the eruption. 

The Bath is Contraindicated: —1. In cardiac weakness 
because of its weakening effect. 

2. In organic diseases of the brain or cord. 

3. In arteriosclerosis and threatened apoplexy. 

4. In febrile conditions. 

The temperature of the bath varies from 98° to 104° F. 
or no° to 112 0 F., according to the condition of the patient 
and the effect desired. 

The duration of the bath varies from two to thirty minutes. 
A temperature of no° F. should never last more than from 
ten to fifteen minutes. 

HOT-WATER BAG 

A hot-water bag may be used as a therapeutic measure in 
a variety of conditions among which are the following: (1) 
to relieve pain in toothache or earache by drawing blood to 
the face and so relieving congestion in the vessels supplying 
the tooth or ear; (2) applied to the abdomen to relieve pain 
due to congestion of the pelvic organs—the uterus, ovaries 
or bladder—and in dysmenorrhea; (3) applied over the 
bladder or to the perineum to overcome retention of urine; 
(4) applied to the abdomen to relieve intestinal or renal 
colic; (5) to relieve pain in neuralgia and sciatica, etc. 

Method of Application. —The temperature of the water 
must always be tested with a thermometer. It may vary 


HUMULUS 


from 120° F. to 150° F., depending upon the thickness of 
the cover used, the area to which the application is made, 
and the condition of the patient and the skin. It must never 
be hot enough to burn the patient should the bag leak or 
the rubber burst. To avoid such serious and inexcusable 
accidents, before use the bag must be carefully examined 
for leakage and for weak places in the rubber. The bag 
must always be completely covered with a suitable cover 
and the patient should be warned and watched to prevent 
him from removing it if he is likely to do so in the desire 
to relieve intense pain. 

The avoidance of unnecessary weight is extremely impor¬ 
tant. If the patient must support the weight of the bag, as 
when applied to the abdomen, it must not be filled more 
than one-third full and all the air must be carefully expelled 
from it. Even this light weight may be unbearable and may 
have to be supported by suspending it from a cradle or by 
some other means of relieving the weight. 

If the application is to be continued, see that the bag is 
regularly refilled and kept hot. Watch the position of the 
bag. The patient may be restless (particularly if in pain), 
displace the bag, roll over on it, and become badly burned. 

Do not leave the bag with the patient longer than the ap¬ 
plication demands. See that it is dried and put away in 
the proper place and in the proper manner. 

HUMULUS (HOPS) 

Hops are the dried cones which consist of scales, of the 
Humulus lupulus, or hop vine, a plant growing in England, 
northern Europe, and the United States. At the base of 
the scales, there is a yellow powder called lupulin. The 
active principle of hops is a volatile oil. When locally 
applied, hops relieve pain and causes redness of the skin. 

When taken internally the following effects are pro¬ 
duced: 

1. It increases the appetite and aids digestion. 

2. It is soothing to the brain and lessens nervousness, 
and may even produce light sleep. 

3. It contracts mucous membranes. 

4. It is said to increase the perspiration. 

Hops are usually applied in the form of bags containing 
the crude hops. These are soaked in water, wrung out, and 
applied locally, or they may be heated and used dry. 

Pillows made from hops are used to induce sleep. 

Preparations 

Lupulin; dose 5 to 20 grains. 

Fluidextract of Lupulin; dose % to 2 drams. 

Oleoresin of Lupulin; dose 2 to 5 grains. 


HYDATIDIFORM MOLE 


HUNTINGTON’S CHOREA 

This is a chronic form of chorea which occurs in adults. 
It is inherited and incurable. The movements consist of 
a series of writhing contortions. Speech is usually markedly 
disturbed, and the intellect gradually weakens to dementia. 
Some cases are depressed and have suicidal tendencies. 
Careful observation must be given and the usual nursing 
measures carried out. One of the difficult problems of the 
nurse is to keep these patients covered while in bed, and 
various devices must be tried to accomplish this, and at 
the same time allow as much freedom of movement as 
possible. Pajama suits in one piece which button closely 
about the wrists and ankles have been found useful, and 
give protection if the covers are thrown off. The bed 
must always be enclosed to prevent falls and injuries. 

HYDATIDIFORM MOLE 

Synonyms. —Hydatid Mole, Hydatidiform degeneration of 
the Chorion, Vesicular Mole. 

This condition is characterized by the villi of the chorion 
becoming changed into strings or clusters of cysts, that vary 
from the size of a tiny currant to that of a grape. Their 
outward resemblance to hydatid cysts explains the name, but 
it must be clearly understood that in their real nature they 
have no connection with echinococcal cysts. 

The condition is rare, not being met with on an average 
oftener than once in 2000 to 3000 pregnancies. It is 
more often found in multiparae than in primiparae, and it 
has been known in a number of cases to recur in the same 
patient. It almost always occurs early, rarely after the fourth 
month. When it occurs early it affects all the villi, and the 
embryo dies, and in most cases is absorbed. If it occurs 
after the placenta has taken definite shape, only a part of 
the placenta may be affected, and if enough is left to suffice 
for the needs of the fetus, it may even continue to live for 
a short time. 

Symptoms and Signs.—(1) As the condition comes on 
early in pregnancy, there will be a history of a short period 
of amenorrhea, as well as some enlargement of the breasts. 

(2) A more rapid enlargement of the uterus than in a 
normal pregnancy. This makes itself obvious by the third 
or fourth month when the uterus may be the size of a six 
months’ pregnancy. This sign is frequent, but is by no 
means invariably present. 

(3) Hemorrhage at irregular intervals, sometimes slight 
and repeated, in other cases profuse or continuous. Occa¬ 
sionally the discharge is mixed with serous fluid, and coi*- 


HYDRAGOGUES 


tains some of the small cysts looking like “white currants 
in red currant juice.” 

(4) The uterus is soft and elastic on palpation, no ballot- 
tement can be made out, no fetal parts felt, and no fetal 
heart heard. 

(5) In some cases the reflex symptoms are excessive, such 
as vomiting, etc. 

(6) The uterus may be tender if overdistended. 

Diagnosis. —The main conditions to be distinguished from 

it are— 

Hydramnios. Here the uterus gives fluctuation, and bal- 
lottement is easily obtained. The uterus usually feels tense 
and elastic. 

Twins. The fetal parts and heart sounds can be de¬ 
tected. 

Pregnancy with ovarian tumor. Here a careful examina¬ 
tion under chloroform will reveal the true condition. 

An absolute diagnosis of hydatidiform mole cannot be 
made unless the characteristic cysts have been observed in 
the discharge. 

Prognosis. —The pregnancy almost always ends prema¬ 
turely about the fourth or fifth month, if not interfered with 
before that. The fetus is almost always destroyed and 
usually absorbed. 

The principal risks are —(1) Hemorrhage, which may be 
fatal at once or after prolonged bleeding. (2) Perforation 
of the uterus by erosion by the cyst epithelium, with conse¬ 
quent hemorrhage into the peritoneal cavity and possibly 
peritonitis. (3) The possible subsequent development of 
chorionepithelioma malignum. 

Early diagnosis and prompt treatment make the outlook 
fairly good, but the continued existence of the mole con¬ 
stitutes a serious danger. 

Treatment consists in the evacuation of the uterus as soon 
as possible after a diagnosis has been made. The most 
scrupulous aseptic and antiseptic precautions are necessary, 
as a woman weakened by bleeding is particularly prone to 
sepsis. 


See Cathartics. 


See Mercury. 


See Hydrastis. 


HYDRAGOGUES 

HYDRARGYRUM 

HYDRASTINE 


HYDRASTIS 


HYDRASTININE 

Hydrastinine is an artificial alkaloid made by oxidizing 
hydrastine. It produces the same effect as hydrastis, but 
it is more efficient and more lasting. 

Hydrastinine markedly contracts the uterus and all the 
small blood vessels. As a result of the latter effect it in¬ 
creases the blood pressure. It is used to check uterine 
bleeding. 

Preparation 

Hydrastinine Hydrochloride; dose % to 2 grains. 

This is given hypodermically in solution, and by the 
mouth in pills or tablets. 

HYDRASTIS (GOLDEN SEAL) 

Hydrastis is obtained from the roots and underground 
stems of Hydrastis canadensis, golden seal or yellow root. 
It is a small shrub growing in the United States. Its active 
principles are the alkaloids, hydrastine and berberine. 

Appearance of the Patient 

After giving hydrastis, or any of its alkaloids, the patient 
usually has a better appetite, and the bowels move more 
freely. If there has been bleeding from the uterus, this is 
gradually checked. The pulse is slow and strong. 

Local action: On the skin, hydrastis has no effect. Ap¬ 
plied to mucous membranes: It increases their secretions. 

Internal Action 

In the mouth: It has a bitter taste and increases the flow 
of saliva. 

In the stomach: It increases the appetite, and aids diges¬ 
tion by increasing the secretion of gastric juice, and the 
peristalsis of the muscle wall of the stomach. 

In the intestines: It increases the secretion and per¬ 
istalsis, causing frequent movements of the bowels. 

The total effect on the circulation is to make the heart 
beat slower and stronger, which causes a slow and strong 
pulse. 

Action on the uterus: Hydrastis contracts the uterus. 

It checks bleeding from the uterus by contracting the 
uterine blood vessels as well as the uterus itself. 

Action on the involuntary muscles: It contracts all the 
involuntary muscles, such as those of the intestines, of the 
iris, as well as those of the blood vessels. 

Hydrastis is said to increase the secretion of bile. 


HYDROCELE 


Excretion 

Hydrastis and its alkaloids are mainly eliminated from 
the body by the kidneys. It is excreted very slowly, much 
slower than it is absorbed, so that cumulative symptoms 
often result from continual administration. 

Hydrastine 

The slow, strong pulse, the contractions of the blood 
vessels, the contractions of the uterus, and other involuntary 
muscles, are due to the action of hydrastine. 

Berberine 

The increased appetite, the increased secretions of the 
stomach and intestines are due to berberine, which is a 
simple bitter. This alkaloid is often found in many other 
plants used as simple bitters. 

Poisonous Effects 

Poisoning from hydrastis or from its alkaloids is ex¬ 
tremely rare. In the few cases that have occurred the 
symptoms were the following: 

1. Vomiting. 

2. Headache. 

3. Dizziness. 

4. Difficult breathing. 

5. Slow, weak, irregular pulse. 

6. Convulsions. 

7. Collapse; and death from failure of breathing. 

Uses 

Hydrastis is used for the following effects: 

1. As a bitter, to increase the appetite and aid digestion 
by increasing the secretion of the gastric juice. 

2. To check uterine bleeding. 

3. For constipation, to make the stools more fluid in 
character. 

Preparations 

Fluidextract of Hydrastis; dose 15 to 60 minims. 

Tincture of Hydrastis; dose 15 to 60 minims. 

Glycerite of Hydrastis; dose 15 to 60 minims. 

This is used principally to relieve inflammations of the 
mucous membranes. 

Hydrastine is rarely used, but an artificial alkaloid made 
from it, hydrastinine, is very frequently used. 

HYDROCELE 

See Testicle. 


HYDROCYANIC ACID 


HYDROCHLORIC ACID, DILUTE 

Dilute hydrochloric acid is used principally to aid diges¬ 
tion in cases where there is an insufficient amount of hydro¬ 
chloric acid secreted in the stomach; and the pepsin is then 
unable to digest the food. This often occurs in such dis¬ 
eases as chronic gastritis, or in infectious diseases. 

It is also used to lessen thirst, especially in fevers, and to 
check intestinal putrefaction and diarrhea. 

Preparations 

Dilute Hydrochloric Acid; dose 5 to 30 minims. 

It contains 10 per cent, of hydrochloric acid. 

For Local Use: Hydrochloric Acid. 

This contains 31 per cent, of hydrochloric acid. 

See Acids, Inorganic. 

HYDROCYANIC ACID, DILUTE 
(Dilute Prussic Acid) 

Dilute hydrocyanic acid is a 2 per cent, solution of pure 
hydrocyanic or prussic acid. It is a colorless, inflammable fluid 
which evaporates very easily. 

Bitter almonds, and the kernels of the seeds of various 
fruits such as peaches, cherries, apricots, plums and prunes, 
contain a glucoside, amygdalin and a ferment, emulsin. When 
the kernels of these fruits are rubbed in water, the emulsin 
changes the amygdalin to prussic acid, glucose (a sugar) and 
another substance. The syrup of wild cherry bark (syrupus 
pruni virginianae) also contains very small quantities of 
hydrocyanic acid. 

1. Applied locally to the skin or mucous membrane, it 

causes numbness by paralyzing the nerve endings of the 
sensory nerves. It is used for this effect to allay itching 
and to check nausea and vomiting. 

2. Given internally, it makes the breathing somewhat 
slower and shallower by lessening the impulses for breathing 
that are sent from the respiratory center. 

Dilute hydrocyanic acid is rarely used except as an in¬ 
gredient of cough mixtures to lessen the cough. 

Hydrocyanic Acid Poisoning 

Hydrocyanic poisoning usually results when the acid, or any 
of its salts are taken with suicidal intent; or from the inhala¬ 
tion of its fumes in a chemical laboratory. It is the most 
powerful poison known. 

Symptoms. —When a sufficiently large dose is taken, there is 
a slight convulsion and death results immediately from paraly¬ 
sis of the heart and respiration. 


HYDROGEN PEROXIDE 


If the dose has not been very large, the following symptoms 
appear in a few seconds: 

1. Nausea and vomiting. 

2. The patient falls to the ground unconscious. 

3. Bloated face and frothing at the mouth. 

4. Dilated pupils. 

5. Protruding eyeballs. 

6. Very slow, shallow and irregular breathing. Often the 
expiration is prolonged, and followed by a long pause, during 
which the breathing seems to have stopped. 

7. Very weak and irregular pulse. 

8. Cyanosis. 

9. Odor of acid on the breath. 

10. Cold, moist skin. 

11. Convulsions, with clinching of the muscles of the 
fingers and toes. 

12. Paralysis of the muscles. 

Death usually results from paralysis of the respiration, 
within fifteen minutes. 

Treatment. —Rapid, vigorous treatment is necessary in 
order to save the patient. Usually, however, the symp¬ 
toms appear so rapidly that death results in spite of the 
most active treatment. If the patient can be kept alive for 
about twenty minutes to a half hour, the chances of recovery 
are increased, as most of the drug is then excreted. 

1. Wash out the stomach. 

2. Give artificial respiration continuously, as long as the 
patient is alive. This helps to eliminate the drug through 
the lungs. 

3. Apply cold applications to the head and spine to keep 
up the breathing. 

4. Iron hydroxide, peroxide of hydrogen or potassium 
permanganate are usually given to neutralize the acid. 

5. Heart and respiratory stimulants are usually given in¬ 
travenously, or hypodermically. 

Preparations 

Dilute Hydrocyanic Acid; dose 2 minims. 

This contains 2 per cent, of hydrocyanic acid. It should 
always be fresh, as it decomposes very easily. 

Potassium Cyanide; dose 1/12 to ^ of a grain. 

HYDROGEN PEROXIDE 

Hydrogen peroxide or hydrogen dioxide is a liquid which 
is a chemical compound of equal parts of hydrogen and 
oxygen. A 3 per cent, solution of hydrogen peroxide is 
used in medicine. 


HYDROPHOBIA 


Local action: Hydrogen peroxide solution is decomposed 
when it comes in contact with organic matter, such as pus 
or blood. It then yields bubbles of oxygen. The oxygen 
then destroys the bacteria with which it comes in contact 
and disinfects the tissues. At the same time it helps to 
loosen the membranes and pieces of dead tissue (sloughs). 
The effect of the peroxide wears off very rapidly. The more 
pus or dead tissue present in the wound, the more oxygen 
is liberated. 

It is used principally to irrigate wounds or sinuses con¬ 
taining pus. It is also used in infections in the mouth and 
throat and other mucous membrane lined cavities. 

Hydrogen peroxide, together with sodium bicarbonate, 
is used to bleach the hair. 

Preparation 

Hydrogen Dioxide (Aqua Hydrogeni Dioxidi). This con¬ 
tains about 3 per cent, of hydrogen peroxide and forms 
about ten volumes of oxygen for every volume of the per¬ 
oxide used. 


HYDROPHOBIA 

Hydrophobia or rabies is caused by the bite of a rabid 
animal, usually a dog. The virus causing the disease is in 
the dog’s saliva which may transmit the disease to man 
through an abrasion or any open wound, not necessarily 
from being bitten. 

The symptoms, in man, develop in from fourteen days to 
seven months after being bitten or otherwise infected. The 
time depends upon the amount of virus introduced, the point 
of inoculation and the susceptibility of the individual. When 
the bite is made through the clothing the saliva may be to 
a large extent removed. As the disease attacks the nervous 
system, when the bite occurs in tissues richly supplied with 
nerves, as in the face, the symptoms develop rapidly. The 
symptoms are headache, pain in the wound extending along 
the nerves, irritability, restlessness, sleeplessness, difficulty 
in breathing and swallowing, due to spasmodic contractions 
of muscles, and a marked increase in the flow of saliva. 
Convulsions usually follow. Death usually follows on the 
third or fourth day after the symptoms appear. 

When the symptoms have developed the disease is in¬ 
variably fatal. Prevention of the disease is therefore of the 
greatest importance. 

Treatment. —A tourniquet is applied above the wound, if 
on an extremity, to prevent the poison entering the general 
circulation. The wound should be incised and opened freely. 
Bleeding is encouraged. It is then cleansed with antiseptics 
and hot antiseptic dressings are applied. 


HYDROSALPINX 


If the animal is known to be rabid the Pasteur treatment 
should be given immediately. This consists in the injection 
of a specially prepared, standardized dose of an emulsion 
of the spinal cord of rabbits which have been treated with 
the virus. The emulsion is given subcutaneously in a series 
of twenty-five inoculations. It stimulates the body to pro¬ 
duce specific antibodies and thus renders the poison intro-’ 
duced in the saliva harmless. The treatment is very costly. 
After the symptoms have developed the treatment is un¬ 
availing. 

The animal which did the biting should, if possible, be kept 
alive and under expert observation in order to determine 
whether rabid or not. Animals, in hot weather, may appear 
“mad” when suffering from heat-stroke. If the animal has 
been killed, the body should be sent to a laboratory where 
the brain may be examined. The presence of certain round 
or angular bodies found within the nerve cells or their 
processes is accepted as diagnostic of the disease. 

See Antirabic Vaccine. 

HYDROSALPINX 

See Fallopian Tubes. 

HYOSCINE 

See Hyoscyamus. 

HYOSCYAMINE 

See Hyoscyamus. 

HYOSCYAMUS 

Hyoscyamus is obtained from the leaves and flowering 
tops of Hyoscyamus niger or henbane, when the plant is two 
years old. It grows best in England, but it has been success¬ 
fully cultivated in the United States. It contains mostly 
hyoscyamine, also hyoscine and small quantities of atropine. 

Hyoscyamine and hyoscine are chemically very much like 
atropine. 

The effects of hyoscyamus are quite similar to those of 
belladonna and atropine, except that they are much weaker. 

Preparations 

Extract of Hyoscyamus; dose V2 to 3 grains. 

Fluidextract of Hyoscyamus; dose 5 to 15 minims. 

Tincture of Hyoscyamus; dose 15 to 60 minims. 

Hyoscyamine 

Hyoscyamine is very rarely used. Its effects are the same 
as those of atropine, to which it is very closely related. It 
lessens the contractions of all the involuntary muscles more 
than atropine does. 


HYOSCYAMUS 


Preparations 

Hyoscyamine Sulphate; dose Y120 to of a grain. 

Hyoscyamine Hydrobromide; dose Vi 2 o to Veo of a grain. 

Hyoscine or Scopolamine 

Appearance of the Patient 

About a half to one hour after the administration of 
hyoscine, the patient feels tired and drowsy. He becomes 
less active, less talkative and soon falls asleep. The sleep 
resembles the normal sleep, and lasts from about five to 
eight hours, though the patient may feel drowsy for some 
time alter that. The pulse and breathing are slow, and the 
pupils are dilated. When the patient awakes, he usually 
complains of dryness of the throat and mouth, and is very 
thirsty. 

Hyoscine produces sleep more easily, if the room is dark¬ 
ened and loud noises avoided. 

The action of hyoscine resembles that of atropine with 
the following differences: 

1. Action on the pupil: It dilates the pupil more rapidly 
than atropine, but the effects last for only a short time. 

2. Action on the heart: It makes the heart beat slower. 
The pulse is therefore slower after hyoscine. 

3. Action on the respiration: Hyoscine does not increase 
the breathing as much as atropine does. 

4. Action on the brain: The activity of the brain is les¬ 
sened by hyoscine. It produces sleep, by lessening the 
action of the sensory areas of the brain. Fewer sensory im¬ 
pressions are then received, consciousness is therefore les¬ 
sened and sleep produced. It lessens especially the remem¬ 
brance ot various sensations. A patient may not remember 
having seen certain objects or having had pain. 

The action of the motor and speech areas of the brain 
is also lessened. The patient is then less active, less talka¬ 
tive and feels tired. 

Occasionally, there is a short period of excitement before 
the patient falls asleep. He may feel dizzy and be quite 
active, though the movements are unsteady, and the speech 
becomes difficult and indistinct. 

Excretion 

Hyoscine is excreted mainly by the kidneys, more rapidly 
than atropine, usually in about eight to ten hours. 

Tolerance 

Patients may get accustomed to hyoscine, so that large 
doses may be given without producing any effects. 


HYPERMETROPIA 


Poisonous Effects 

The poisonous effects of hyoscine are similar to those of 
atropine. The patient has the characteristic symptoms of 
wild, talkative delirium, dryness of the throat and mouth, 
dilated pupils, dry red skin, rapid pulse and breathing, etc. 

Uses 

Hyoscine is usually given hypodermically, to produce 
sleep; especially in cases of delirium, mania, delirium 
tremens, etc. It may cause collapse, however. 

Preparations 

Hyoscine Hydrobromide; dose %oo to Vioo of a grain. 

Scopolamine Hydrobromide. 

This is the same as hyoscine hydrobromide. 

See Belladonna. 


HYPERMETROPIA 

See Accommodation. 

HYPERPITUITARISM 

See Pituitary Gland, Diseases of. 

HYPERTHYROIDISM 

See Thyroid Extract. 


HYPNONE 

Hypnone is a colorless liquid formed from alcohol. It 
has a characteristic odor like that of oranges. It produces 
sleep but it is not very efficient. Dose, 5 to 15 minims. 

HYPNOTICS 

Hypnotics, soporifics, narcotics, or somnifacients, are 

drugs which lessen the activity of the brain, and produce 
sleep, or unconsciousness. 

Their effects are similar to those of the general anesthet¬ 
ics, but they are milder, more lasting, and do not relieve 
pain. 

The hypnotics are usually given by the mouth and are 
slowly absorbed; their effects lasting for several hours. 

The chief hypnotics are as follows: Bromides, chloral, 
sulphonal, trional, tetronal, veronal, paraldehyde, urethane, 
chloralformamid, chloretone, chloralose, bromural, bromoform, 
amylene hydrate, hypnone, hedonal, isopral, neuronal, dor- 
miol. 

Most of the drugs used as hypnotics are substances of a 
comparatively complex chemical structure and are slowly 
absorbed. They are usually given for effects that are to last 


HYPODERMIC ADMINISTRATION OF MEDICINE 


for several hours. They should be administered in a tumbler¬ 
ful of warm milk or beer, about a half to two hours before 
the usual bedtime, the actual time depending on the rapid¬ 
ity with which the particular drug is absorbed. 

The slow absorption of a substance such as sulphonal 
may be somewhat increased by giving it in milk well diluted 
with water. 

The nurse should avoid giving chloral in small quantities 
of water, which tend to cause irritation of the stomach and 
rapid absorption. 

When giving hypnotics by the rectum they should be 
dissolved in about two ounces of boiled starch and injected 
into the rectum through a catheter by means of a syringe. 

HYPOCHLORHYDRIA 

This means lack of hydrochloric acid in the gastric juice. 

Dietetic Treatment.- —The following points must be kept in 
mind in formulating a dietary for patients suffering from a 
deficiency of hydrochloric acid: (i) boil the drinking water 
to destroy any bacteria which may be present; (2) use car¬ 
bohydrates in the form of starch rather than sugar, since 
starch is less liable to fermentation from bacteria than sugar; 
(3) limit the foods which delay the passage of the food mass 
from the stomach; fats pass into the duodenum more slowly 
than other foods and when fed with other foods delay their 
passage materially; (4) avoid the use of soda bicarbonate, 
as it tends to reduce the normal acid content of the stomach, 
thus preventing its germicidal action upon the fermentative 
bacilli; alkaline carbonates likewise inhibit the flow of gastric 
juices; (5) give especial attention to the attractiveness of 
the food served; let it be appetizing and savory, for by such 
means is the appetite juice and incidentally an increased flow 
of the gastric juices stimulated; (6) condiments and spices, 
meat broths high in extractives, and salt foods such as caviar 
and endives may be given at the discretion of the physician; 
it is seldom advisable to give the foods which are indi¬ 
gestible, even when they act as stimulants to the secretory 
cells of the stomach. 

HYPODERMIC ADMINISTRATION OF MEDICINE 

The best sites for hypodermic injection are the front of 
the thighs, the outer part of the arms and forearms. The 
skin at the site of injection should be sterilized by rubbing 
with 50 per cent, alcohol. The sterilized syringe is now 
filled with a well diluted solution of the drug to be given 
and held in the right hand with the neck of the syringe 
resting between the index and middle finger with the thumb 
on the piston. The skin at the site of injection is then taken 


HYPODERMIC ADMINISTRATION OF MEDICINE 


between the thumb and index finger of the left hand and 
the needle inserted under the skin at an angle of about 45 
degrees. The place of injection should then be thoroughly 
massaged. 



The correct way to give a hypodermic injection. (Note the 
direction of the needle.) 

(From Blumgarteris Materia Medica) 



The wrong way to give a hypodermic injection. 

(From Blumgarten’s Materia Medica) 






HYPODERMOCLYSIS 


In giving a hypodermic injection it is very essential to 
inject the drug under the skin, not into the skin. When the 
drug has been injected into the skin the area of injection 
looks like goose skin and the needle should be withdrawn and 
a new place chosen. This should be sterilized and the in¬ 
jection repeated. 

The effects of a hypodermic injection usually appear in 
about ten minutes to a half hour, depending upon the pa¬ 
tient’s circulation; the better the circulation the more rapid 
are the effects. 

It may also be noted that the more the drug is diluted the 
better and the more rapid are the effects following a hy¬ 
podermic injection. 


HYPODERMOCLYSIS 

Hypodermoclysis is a method of supplying fluid to the 
body by injecting normal saline, or Locke’s solution, into the 
subcutaneous tissues. 

The therapeutic uses of a hypodermoclysis are much the 
same as those described under an intravenous infusion, so 
need not be repeated. 

The effects of the treatment are also much the same, the 
difference being chiefly in the rapidity with which the results 
are obtained. The fluid injected is rapidly absorbed by the 
blood vessels, especially after a hemorrhage, with results 
identical, although not so rapidly obtained as when given by 
intravenous injection. 

The treatment, like an intravenous injection, is contraindi¬ 
cated in any form of edema. 

The solutions used are the same as when given intraven¬ 
ously. 

The temperature of the solution is 120° F. 

The amount of solution may be from one to two pints, 
given slowly. 

Site to be Prepared. —The solution may be introduced be¬ 
neath the skin of the abdomen, below the breast, in the 
thighs, buttocks, or in the axillary line. 

The articles required for the treatment will be a rubber 
dressing sheet, sterile towels to drape the area, disinfectants 
for the skin, sterile absorbent cotton, the sterile solution, 
thermometer, flask, tubing (with glass connecting tip to de¬ 
tect air bubbles) and needles. Sometimes injections are 
made in two places simultaneously; in that case a glass T 
connecting tip with two short pieces or rubber and two 
needles will be required. A sterile dressing—a collodion 
dressing or gauze and adhesive—a paper bag and kidney 
basin will also be required. 

Method of Procedure. —The flask should be held or secured 


HYPOPITUITARISM 


about two feet above the patient. The doctor connects the 
sterile tubing, etc., disinfects the skin, and inserts the 
needles. The nurse’s duties are to prepare the patient, to 
assist the doctor as required, to watch the rate at which the 
fluid is absorbed, to see that the fluid does not become too 
low, and as it may run in very slowly, to see that the tem¬ 
perature is maintained. As the fluid enters a slight local 
swelling develops which disappears as absorption takes place. 
Very gentle rubbing will aid the absorption. 

When this treatment is given, the condition of the patient 
is frequently critical. The greatest care must be taken to 
avoid exposure and chilling. The nurse should watch the 
patient’s color and pulse closely. 

See Intravenous Infusion. 

HYPOPITUITARISM 

See Pituitary Gland, Diseases of. 

HYSTERECTOMY 

See Uterus. 

HYSTERIA 

Cause: Uncontrolled nerves often due to overfatigue, 

or nerve strain, or habitual lack of self-control. 

Symptoms: In appearance, the symptoms are rather 

negative. The body is warm, the color and pulse normal. 
The patient acts in an uncontrolled way, sometimes grind¬ 
ing the teeth, or thrashing around, and alternately weeping 
and laughing. 

Treatment: Leave the patient unnoticed as much as pos¬ 
sible in order that she may get control of herself. Speak 
sharply to attract attention and divert the mind. Sprinkle 
cold water or apply a cold sponge to the face. A warm 
bath often gives immediate relief in such cases, and com¬ 
plete rest is required afterwards as the patient has had a 
certain amount of strain, both physical and nervous. 

(And see Psychoneuroses). 


I 


ICE-BAG, APPLICATION OF 

Method of Filling and Applying an Ice-Bag. —An ice-bag 
should be fitted to the part and should contain small, smooth 
pieces of ice or crushed ice only. It should be light in 
weight and, when used continuously, as in heart diseases, 
should be suspended to relieve the weight. A bandage, 
binder, or special suspender should be used to hold it in 

place and at the same time to relieve the weight. When 

used for the abdomen or an injured limb it may be sus¬ 
pended from a bed cradle so that it just rests on the part. 
When used for the head, it may be suspended from the 
head of the bedstead. The bag should not be more than 
half full. When filling the bag expel all the air both to 

lessen the weight and to prevent the ice from melting. If 

the air is not expelled the bag will not fit and remain in 
position. When in use, also to lessen the weight, expel the 
water which forms as the ice melts. See that the bag does 
not leak. 

An ice-cap should never be applied directly to the skin. 
Lawsuits have been brought against doctors and hospitals 
because of injuries to the tissues produced in this way. A 
protector between it and the skin must always be used. 
Flannel is best because it protects the tissues from the rapid 
withdrawal of heat, and makes the application less intense, 
just as flannel protects from the cold in winter better than 
cotton. Flannel also absorbs the moisture of condensation 
which forms on the outside of the bag. A cover is neces¬ 
sary to prevent this moisture from wetting the bedding or 
the patient. The bag must be refilled when necessary so 
that the temperature of the application will be maintained. 

See Cold. 

ICE-BOX 

Care of Ice-Box and Contents. —The ice-box plays an 
important role in the preservation of the health and comfort 
of the family, as well as that of the invalid. Therefore the 
first consideration is the cleanliness of it. The old-fashioned 


ICE-COIL 


boxes were constructed without ventilation. This was clearly 
a mistake, since many foods absorb both the odor and flavor 
of the substances about them if allowed to stand for any 
great length of time in a closed compartment with them. 
The ice-boxes or refrigerators of to-day have a ventilation 
system which insures a circulation of air constantly through¬ 
out the interior of the box. The drain pipes require special 
attention, because no matter how clean the box itself is 
kept, the melting of the ice causes a slime to accumulate on 
the inside of the pipe which will clog it and become offensive 
unless it is flushed out often. This may be accomplished by 
pouring through it a solution made by dissolving one-half 
ounce of borax, washing soda, or ammonia in one gallon 
of boiling water. The adjustable part of the pipe can be 
removed and cleaned with a long brush made for the pur¬ 
pose. The pipe is then replaced and the boiling water poured 
through. In this way the entire drainage system of the box 
is completely cleaned. All loose bits of food which may 
drop from the containers to the floor and shelves should be 
carefully removed each day and the interior of the box and 
shelves thoroughly wiped out. Three times a week is suffi¬ 
cient to wash and flush the box and pipes unless milk, cream, 
or other food materials have been spilled, in which case it 
should be washed at once before it has an opportunity to 
sour or spoil and become offensive. Ice should always be 
washed off before being put in the box, and all milk and 
cream bottles should likewise be wiped with a clean wet 
cloth before being placed on the ice. 

Hot food must never be put in the ice-box, as the heat 
from the food will raise the temperature of the air in it. 
In some cases the sudden chilling of the food itself is 
undesirable, but this is not so often the case. However, 
the best results are obtained by first allowing the food to 
cool, and then placing it on ice. This is particularly the 
case, with jellies made from gelatin. 

ICE-COIL 

The ice-coil is a convenient substitute for the ice-bag 
when cold is to be applied continuously. It is lighter, more 
pliable, may be more easily fitted to the part and the tem¬ 
perature can be kept constant. It consists of a flat coil 
of rubber tubing, with two loose ends about two yards long, 
through which cold water is passed. 

Conditions in which the Ice-Coil is most Commonly 
Used. — i. Applied to the head in fevers, meningitis, cerebral 
hemorrhage and conditions accompanied by cerebral con¬ 
gestion to contract the blood vessels, check bleeding, inflam¬ 
mation and congestion, and to act as a sedative in delirium. 


ICHTHYOL 


2. Applied to the chest in hemoptysis, pleurisy and pneu¬ 
monia to check bleeding, inflammation, and congestion; to 
relieve pain, dyspnea and coughing, and to calm an irritable 
heart and slow the pulse in pneumonia. It stimulates vital 
nerve centers, relieves toxemia, and lowers the temperature. 

3. Applied to the left side of the chest in endocarditis, in 
pericarditis, and in fevers, such as typhoid and pneumonia, 
with a rapid, bounding pulse. 

Method of Application. —When an ice-coil is to be ap¬ 
plied a bucket containing water and ice is placed on a chair 
or stand at the side of the bed. The ice should be covered 
with gauze to prevent any particles from the melting ice 
from clogging the tubing. A second bucket or pail is placed 
on the floor or on a low stool for the return flow. The air 
may be expelled and suction created in the tubing by first 
attaching a funnel to the end through which the water 
enters and pouring water through. Before it has all quite 
run through, the end of the tube should be placed in the 
water in the bucket on the stand. The ice water should 
then run continuously. The water in the pail on the floor 
may be poured back into the bucket and kept at the right 
temperature by adding ice to it. Sometimes instead of a 
bucket and flow of water by sipnonage, a water cooler is 
used from which water flows by gravity. 

Preparation of the Patient .—As in all cold applications, 
the patient’s feet and body must be warm and the applica¬ 
tion must not be allowed to cause prolonged chilly sensa¬ 
tions. The area to which the cold is applied should be warm 
before the application is made. To protect the skin from 
the intense cold, a moist compress is placed between it and 
the coil. The skin must be closely watched for discoloration 
and numbness. 


ICHTHYOL 

Ichthyol is a dark brown, oily looking sulphur compound 
soluble in water and oils, but not in alcohol. Its therapeutic 
value depends largely upon the sulphur ingredient. 

It is used as a counterirritant either in the form of an 
ointment (10 to 50 per cent.) or as a 50 per cent, solution. 

Conditions and Purposes for which Ichthyol is Used.— 

1. In acute articular rheumatism to relieve pain, tender¬ 
ness and stiffness. Ichthyol ointment may be smeared over 
the inflamed part or spread on lint, which is then wrapped 
about the joint. After the acute stage has passed the oint¬ 
ment may be rubbed in. 

2. In acute sprains and swollen glands to lessen pain and 
swelling. 


IDIOSYNCRASY 


3. In erysipelas and chronic skin diseases such as acne 
and eczema. 

4. In burns, sunburn, frostbites, and chilblains, corns and 
bunions, to relieve pain and swelling. 

5. In boils or carbuncles, bedsores and other sloughing or 
infected areas to promote the absorption of waste products 
and stimulate healing. It is thought to favor local resist¬ 
ance by promoting a local leucocytosis. 

In pelvic inflammation with an inflammatory exudate 
and vaginal discharge. A tampon or gauze saturated with 
the solution is inserted in the vagina. 

The Method of Application. —Ichthyol is seldom applied by 
rubbing. It is usually painted or smeared over the part 
with a cotton swab or camel’s-hair brush. It may be applied 
to lint or gauze which is placed over the part. In any case 
it should be covered by a dressing lightly but securely fast¬ 
ened in place in order to prevent staining of the bed linen, 
etc. Ichthyol is usually applied in the form of an ointment. 
Ichthyol alone is soluble in water and so is easily removed 
from linen but when mixed with vaselin, the oil fixes the 
stain, prevents its removal, and so leaves a very unsightly 
stain. A preparation of ichthyol and collodion is sometimes 
used for corns and bunions, etc. It does not stain. 

IDIOSYNCRASY 

Some individuals get unusual, opposite, even poisonous 
effects from ordinary doses of certain drugs. Occasionally 
even large doses of certain drugs produce no appreciable 
effects. Such effects are called idiosyncrasies or untoward 
effects. They occur in two forms: 

(a) Idiosyncrasy of Effect: This is a condition when 
small or ordinary doses of a drug cause no effects, unusual, 
opposite or poisonous effects. For example, morphine is a 
drug which usually produces sleep and quiets the patient. 
In some individuals it causes excitement and wakefulness. 

(b Idiosyncrasy of Dose: This is a condition where even 
large doses of a drug cause no effects at all. 

ILLUSIONS 

Illusions are misinterpreted sense impressions. There 
is always an external stimulus to furnish the impression, 
but it is interpreted falsely, as for example, the cord of a 
bath robe which is detached from the garment may be inter¬ 
preted to be a snake, or the branch of a tree swaying in the 
wind may be mistaken for a beckoning hand, or the sound 
of a whistle may mean the call of a human voice. The nor¬ 
mal mind at times misinterprets sense impressions, but it 
soon corrects the error. In mental disease the illusion per- 


IMMUNITY 


sists, ils believed in and consequently influences behavior. 
There may be illusions of all the senses, but those of hear¬ 
ts* sight and touch are most frequent. 

IMMUNITY 

Immunity to a disease may be defined as a condition of the 
body such that the germs of that disease will not develop 
in the body or, if the germs do develop, the poisons they 
secrete will not injure the body. 

The possession by certain species of animals of immunity 
to diseases affecting other species has long been recognized; 
for instance, horses do not take measles. So also has the 
possession by certain individuals of an immunity not shared 
generally by others of the same species; for instance, many 
persons will not take diphtheria. 

The explanation offered to-day is briefly this—such im¬ 
munity is due to manufacture by the body of antidotal sub¬ 
stances, sometimes directed against the germ, sometimes 
against the poisons, but in either instance eliminating the 
harmful effects. 

The presence of the antidotal body may be congenital 
(born with the person), constituting “natural immunity”; 
or may be “acquired” in several ways in later life; by an 
attack of the disease, as in measles; by the artificial implan¬ 
tation of a living germ (virus) as in small-pox; by the arti¬ 
ficial injection of a dead germ (vaccine) as in typhoid fever; 
or by the artificial injection of a germ-poison (toxin) as in 
immunizing horses against diphtheria in order to produce 
antitoxin. 

All these methods stir up the body to make its own anti¬ 
dote, and hence the immunity thus obtained is known as 
“active immunity.” Such immunity is generally as strong 
and as lasting as can be had under the present state of our 
knowledge. 

If, however, instead of using a germ or a germ-product to 
stir up the body to make its own antidote, we borrow enough 
ready-made antidote to confer immunity from another body 
already immunized, already in possession of the antidote, 
the immunity thus conferred is known as “passive immunity ” 
Such borrowed immunity is of inestimable service in the 
treatment of diphtheria, where the blood serum containing 
the antitoxin is borrowed from an immunized horse; and it 
has been successful in pneumonia and in poliomyelitis, where 
the blood serum containing the antidotal substance is bor¬ 
rowed from previous patients who have recovered; their re¬ 
covery being evidence that they have manufactured corn 
siderable quantities of the antidote themselves. 

But since it is borrowed, since it is not the result of a 


IMPETIGO CONTAGIOSA 


stirring up to make its own antidote of the body on whose 
behalf it is borrowed, such passive immunity, while invalu¬ 
able for the moment in meeting the acute exigency due to 
the poisoning from which the patient is already suffering, 
does not last; it does not confer an active immunity such 
as would be conferred if that body hfid succeeded in learn¬ 
ing to make its own antidote. 

See Infectious Diseases, Course of; and Serums. 

IMPETIGO CONTAGIOSA 

See Skin Diseases. 

IMPULSIVENESS 

Impulsiveness is shown by sudden acts which are the 
responses to uncontrollable thoughts or feelings. These 
responses are in no way premeditated, for the idea barely 
comes into consciousness and is immediately transformed 
into action without thought of the consequences. Unpro¬ 
voked attacks upon other patients and upon the nurses are 
frequently of this nature, as also are the hazardous and 
dangerous activities to which the patient is impelled fre¬ 
quently by hallucinations. 

INDIAN HEMP 

See Cannabis Indica. 

INDICAN, TEST FOR 

See Urine. 

INFANT, CARE OF 

A healthy infant should spend the first few weeks of its 
life in sleeping and feeding. Habits begin to be acquired 
from the first day, and it is most essential for the welfare 
of the child, as well as for the comfort of the mother and 
other members of the household, that from the very outset 
the child should be trained to the utmost regularity in re¬ 
gard to its sleeping and its meals. Disregard of this point 
in respect of feeding has been well said to be sowing the 
“wind,’ and is certainly followed by reaping the whirl¬ 
wind ! 

The child should be put to the breast three or four times 
the first day. This teaches the child to suck, and it swallows 
some colostrum which has a beneficial laxative effect upon it. 
After the milk comes, the child should be put to the breast 
regularly every two hours during the day and every three 
hours at night. The most usually convenient hours are 8, 
io, 12 noon, 2, 4, 6, 8, ii, p.m., and 2 and 5 a.m. The 
breasts should be used alteyiately, and great care must be 


INFANT, CARE OF 


taken to preserve the nipples from cracking. They should 

he wiped with a clean handkerchief dipped in sterile water 

before each feed, and, after the feeding is done, should be 
lightly smeared with boroglyceride, or boracic solution. The 

child s mouth should be wiped out at the same time and in 

the same way to avoid the occurrence of thrush. 

In the first two days before the milk is secreted, the child 
should be given occasionally a teaspoonful of warm steril¬ 
ized water, preferably without sugar. 

The infant loses several ounces in weight during these 
two days without food, but by the end of the first week it 

should have made them up again, and be the same weight 

as at its birth. After that it should put on from 5 to 7 

ounces a week, and this should be checked by its being 

weighed once a week regularly. 

A healthy infant has about four to six movements of the 
bowels in the twenty-four hours, and urinates about twice 
as often. 

The cord must be kept strictly aseptic. It must be care¬ 
fully dried after each bath, powdered if necessary, and 
dressed in sterile gauze or lint. After the cord drops off, 
the umbilical scar should be dressed in the same way, no 
pads being used, but merely a piece of aseptic dressing kept 
in place by the binder. 

In fine weather the child may be taken out on the third or 
fourth day, and may with great advantage be trained to sleep 
outside. In winter the first outing should be delayed until 
a favorable day occurs. 

Management of Premature Infants. —A premature infant 
has difficulty in maintaining its body heat. It is therefore 
imperative to keep it warm, without at the same time over¬ 
heating it. This is best done by keeping the child in an 
incubator in which the temperature can be kept at about 
78° F. with more or less exactitude. Failing such con¬ 
veniences much may be done by wrapping the child in cot¬ 
ton wool, and keeping its cot near the fire, and free from 
draughts in a room with a temperature of 72 0 F. The infant 
should not be bathed, but merely smeared with warm olive 
or neat’s-foot oil, care being taken to keep it warm during 
the process. The feeding requires the greatest care and 
patience. The stomach is very small and the child may be 
too weak to suck. If so, it must be fed with a small tea¬ 
spoon or a glass pipette very slowly. It is of the first im¬ 
portance that it should be fed on breast milk, with, perhaps, 
the addition of a little peptonized whey. The feeds should 
be given every hour or so, and should be started very soon 
after birth. If at this time there is not even colostrum in 
the mother’s breast, some peptonized whey must be given 


INFANT FEEDING 


until the breast is available. At the same time fluid should 
be supplied by one or two enemata of half an ounce of nor¬ 
mal saline solution daily. As soon as the child can suck 
it should be put to the breast, or else the milk drawn off 
and fed through a rubber teat. The enemata may be dis¬ 
continued after feeding is thoroughly well established. 

INFANT FEEDING 

In all cases an infant should be suckled by its mother 
unless definite contra-indications exist. If the advantages 
to the child and to herself are laid before the mother, few 
women will refuse the privilege. For the infant it is the 
natural and ideal food, alike in its composition and in its 
freedom from contamination. For the mother it is an ad¬ 
vantage in that it stimulates the processes of involution of 
the uterus. Even a few weeks of breast-feeding give the 
child’s digestion a good start, and fit it for subsequent arti¬ 
ficial feeding if the lactation becomes a strain to the 
mother. 

The simple rules for breast-feeding have already been given 
(see Infant, Care of). It is only necessary to insist again 
on the paramount importance of regularity in the times of 
the feeds. 

Contra-indications to Breast-feeding. —The following ma¬ 
ternal conditions make suckling undesirable: 

1. Tuberculosis, either active or latent. 

2. Chorea. 

3. Serious complications during or after labor, e.g., hem¬ 
orrhage, septic infection, eclampsia. 

4. Absence of milk. 

5. The occurrence of pregnancy during lactation. 

6. Acute illness occurring during lactation. 

On the part of the infant, contra-indications to the con¬ 
tinuance of breast-feeding are: 

1. Continuous loss of weight. 

2. Persistent and intractable indigestion. 

In such cases the infant must either be fed by a wet nurse 
or else be placed wholly or in part upon artificial feeding. 

Wet Nursing. —This is the best substitute for the milk 
of the child’s own mother. It is, however, a very expen¬ 
sive method, and with the improvements in our knowledge 
and methods of bottle-feeding it has gone greatly out of 
fashion. If it is decided to wet nurse the child, it is the 
physician’s duty to choose the nurse. This is a matter of 
great importance, as tubercle and syphilis may be trans¬ 
mitted to a child by the milk. The foster motlicr should be 
a woman between twenty and thirty, and her own child 
should be very little older than the infant to be nursed. 


INFANT FEEDING 


She must be carefully examined for evidences of disease, 
the throat, tongue, teeth, skin, and hair being inspected. 
The breasts and nipples must also be examined. Her own 
infant should be seen and examined for signs of syphilis 
or other disease. The greatest care must be exercised in 
every way, and in cases of doubt the Wassermann test for 
syphilis should unhesitatingly be applied. 

Mixed Feeding. —Where the supply of mother’s milk is 
insufficient, artificial feeding may be substituted several times 
in the twenty-four hours, without putting the child wholly 
on the bottle. This mixed breast and artificial feeding is 
superior to entire artificial feeding, and infants thrive on it. 
The bottles may be substituted at whatever times are most 
convenient, but the process of substitution should be gradual, 
one bottle being given to start with, and afterwards the 
number gradually increased if desired. 

Artificial Feeding. —In this country cow’s milk is the most 
convenient substitute for breast milk. The comparative 
composition of the two milks is as follows: 


Composition. 

Breast Milk 

Cow's Milk 

Proteid— 

Casein and Lactalbumen. 

Fat . 

Per cent. 

i .5 

A 

Per cent. 

3-5 

A 

Carbohydrate (sugar) . 

7 

5 

Mineral salts . 

0.2 

0.7 

87 

Water . 

87 



From a study of this table it will be seen that cow’s milk 
differs from breast milk in having too much proteid and too 
little carbohydrate. There is, however, an even more im¬ 
portant difference in the nature of the proteid. In both it 
consists principally of casein and lactalbumen, the former 
of which is converted by the rennet of the stomach into a 
solid curd, while the latter remains practically fluid, and is 
therefore much more easily digested. In breast milk more 
than half the proteid is in the form of lactalbumen, while 
the casein forms a fine curd with the rennet. In cow’s 
milk, on the other hand, the greater part of the proteid is in 
the form of a casein which forms a dense curd with rennet, 
and only about one-fifth part consists of lactalbumen. 

Cow’s milk must, therefore, be diluted before it becomes 
suitable for the infant. But here again we are met with a 
difficulty, for mere dilution not only does not affect the 
nature or the relative proportion of the two forms of the 
proteid, but it brings the proportion of fat and carbohydrate 














INFANT FEEDING 


below what it ought to be. To make a suitable mixture with 
cow’s milk, we must not only dilute it, but add to it fat and 
carbohydrate—usually in the forms of cream and sugar 
of milk. 

Rules for Artificial Feeding during the first Two Months. 

—During the first two days a child that is to be artificially 
fed should get but little nourishment, for nature does not 
provide any milk during these days, and it is well to follow 
the natural plan as closely as possible. A little warm steril¬ 
ized water with a small pinch of sugar of milk may be 
given occasionally on the second day, and on the third day 
it may be given one or two teaspoonfuls of a mixture of 
milk and water in the proportion of one to ten, with a little 
sugar of milk. On the third day a regular and definite 
plan of feeding should be adopted. The important points 
are the times, quantity, and composition of the feeds. 

Times .—These should be the same as for breast-feeding, 
and sjiould be adhered to strictly (see Infant, Care of). 

Quantity .—Some variation must be made for the size of 
the child, but for an infant of average size a feed should not 
be more than one ounce during the first ten days. It may 
then be gradually increased, so that at the end of the 
first month it is two ounces, and at the end of the second 
month three ounces. If a healthy infant is given too large 
a feed, it generally indicates the fact by vomiting some of 
it shortly afterwards. 

Composition .—Details of the various methods of . artificial 
feeding are to be found in books on the subject, and all 
that is necessary here is a sketch of a simple and thoroughly 
serviceable plan of feeding for the first eight weeks. 

(a) Mixture to be given from the Third to the Tenth Day. 

Milk . y 2 tablespoonful. 

Sugar of milk . teaspoonful. 

Water .tablespoonfuls. 

Dissolve the sugar of milk in the water before adding the 
milk. Scald the mixture before use. Give every two hours 
during the day and twice at night. 

Gradually increase the quantities of the ingredients every 
third day, so that at the tenth day the mixture is as below: 

( b ) Mixture to be given from the Tenth Day. 


Milk . y 2 to 34 tablespoonful. 

Sugar of milk . y 2 teaspoonful. 

Cream . y 2 teaspoonful. 

Water .ij 4 tablespoonfuls. 


Again gradually increase the ingredients until at the 
beginning of the second month the mixture is as follows: 









INFANT FEEDING 


(c) Mixture to be given from the Beginning of the Second 

Month. 

Milk .i Yz tablespoonfuls. 

Sugar of milk . 34 teaspoonful. 

Cream .i teaspoonful. 

Water . 2*4 tablespoonfuls. 

Gradually increase the intervals between the feeds, so 
that at the end of the second month the infant is being fed 
every two and a half hours during the day, and only once 
at night if possible. 

Gradually increase the ingredients so that at the end of 
the second month the mixture is as follows: 

(d) Mixture to be given from the Beginning of the Third 

Month. 

Milk . 2 x / 2 to 3 tablespoonfuls. 

Sugar of milk .i teaspconful. 

Cream .2 teaspoonfuls. 

Water .3 tablespoonfuls. 

Temperature. —In all cases the temperature of the mixture 
should be ioo° F. 

Use of Lime-Water, Barley Water, etc. —Nurses and 
mothers are fond of adding barley water to the mixtures 
because it makes them look more nutritious. An infant 
cannot, however, digest starchy matter, so that the barley 
passes through unaffected, and is apt to set up irritation. 
The same applies to oatmeal water. Lime-water has the 
effect of making the curd finer and lighter, and so making 
the mixture more digestible. It has also a constipating effect. 
While, therefore, there are not the same objections to its use 
as to the use of barley water, it should not be given unless 
the child seems unable to digest the plain mixture, or there 
is some diarrhea. It should be given in the proportion ot a 
tablespoonful to three ounces of the mixture. Citrate of 
soda added to the mixture has the effect of preventing the 
formation of curd, the milk remaining fluid. This is of 
value where the infant is unable to digest the curd. The 
citrate is conveniently added in the form of a solution in 
distilled water, two grains of citrate being required for each 
ounce of milk. 

The Bottle. —The old-fashioned bottle with a long rubber 
tube is a perfect abomination, as it is impossible to keep it 
clean. There is also a tendency amongst busy working 
women to place such a bottle in the cot beside the child, and 
let it take its meals when it feels inclined. This always leads 
to indigestion and bad health sooner or later. Practically 










INFANT FEEDING 


all modern bottles have simply a teat, which can be easily 
and quickly cleansed and sterilized. The hole in the teat 
should be of a size to allow the milk to drop out rapidly on 
inverting the bottle, but not actually to run out. Both teat 
and bottle must be kept absolutely clean. The former should 
be turned inside out and washed, and the latter brushed out 
immediately after use, and both kept in a basin of boiled 
water till again needed. At frequent intervals they should 
be sterilized by scalding. Under no circumstances should 
the milk be allowed to remain in the bottle for the next 
feed. 

The Question of Sterilization .—One of the greatest advan¬ 
tages of breast milk is that the infant receives it direct from 
the nipple, and it is therefore sterile. Cow’s milk obtained 
even under the best circumstances is far from sterile, and 
under ordinary town conditions the number and variety of 
organisms found in it are truly appalling. The rarity with 
which breast-fed children are attacked with serious diarrhea 
is very significant, when we consider that amongst bottle- 
fed children epidemic diarrhea is a scourge. It is believed 
also that tuberculosis is frequently conveyed to the infant 
by infected milk; and outbreaks of scarlet fever and diph¬ 
theria are often to be traced to the same source. 

The advantages of sterilizing the milk would therefore 
seem to be overwhelming. But it is only right to state that 
there are disadvantages also. Boiling the milk spoils its 
taste, and, while that is a detail to an infant that is brought 
up on it from its birth, it has a more serious influence in 
destroying some valuable ferments in the milk. The con¬ 
tinued absence of these ferments sometimes leads to in¬ 
fantile scurvy. 

This disadvantage of sterilization can be circumvented with¬ 
out the sacrifice of the advantages by the process of “scald¬ 
ing.” The milk is brought to the boiling point and kept at 
that temperature for two minutes and then cooled rapidly. 
This is simple and effective in that it destroys all organisms, 
although the spores of organisms may survive. “Pasteuriza¬ 
tion” is also satisfactory, but more complicated. In this 
process the milk is brought to a temperature of 158° F. 
and kept there for twenty minutes. A drawback is that the 
tubercle bacillus may survive the process. 

Patent Foods .—Speaking generally, patent foods are never 
so good as a simple milk and cream and water mixture, and 
if the rules as to the times, quantity, and method of prepara¬ 
tion are carefully attended to, few infants will fail to thrive 
on it. The advantage of foods is that the rules are all 

rinted on the bottle or tin, and command attention, whereas 
the physician as often as not does not even write down the 


INFECTIOUS DISEASES 


rules, but contents himself with a few verbal instructions, 
which are soon forgotten. 

Most patent foods contain starchy material which the infant 
is unable to digest, along with an excess of sugar which 
makes it fat but flabby, and too little real fat. 


INFECTIOUS DISEASES, COURSE OF 

Although each infectious disease has its own peculiarities, 
by which it can be recognized, yet all show a certain family 
resemblance, present a more or less similar history, follow 
a more or less similar course, spread by more or less similar 
means, inflict more or less similar damage, and can be 
combated by more or less similar procedures; while nearly 
all of them confer one (very costly) boon, a more or less 
complete immunity to a subsequent attack of the same dis¬ 
ease. 



It 

a® 


Q 



Fastigial -§(3 
Period Q 



Diagram of the General Course of an Infectious Disease 

1 = date of entry of germs to body; 

corresponds with n = date of exit of germs from 
the body. 

2 = period of increase of germs; 

corresponds with 10 = period of decrease of germs. 

3 — date of first symptoms; 

corresponds with g = date of last symptoms. 

4 = period of increasing illness; 

corresponds with io = period of decrease of germs. 

5 = date of symptom characteristic of the disease in 

question; 

corresponds with 7 = date of symptoms beginning ti 
vanish. 

6 = period of height of the disease. 





INFECTIOUS DISEASES 


One of the many points which our ordinary infectious dis¬ 
eases have in common, is this—each depends absolutely for 
its appearance on the same essential, the introduction, to 
the body, of the germ of that particular disease. As you 
cannot produce strychnine poisoning by swallowing opium, 
as you cannot produce opium poisoning by swallowing 
strychnine, so you cannot contract diphtheria, except from 
the diphtheria germ, or tuberculosis except from the tuber¬ 
culosis germ. 

Since no infectious diseases can develop until the germ of 
that disease enters the body, the study begins with that entry 
to the body, however the entry may be effected. The day 
on which this entry occurs is known as the date of in¬ 
fection. The history of the disease in that particular body 
begins then. The disease itself does not at once show itself, 
however. An interval, known as the incubation period, in¬ 
tervenes between infection and the actual development of the 
illness. 

The actual date of infection cannot by any means always 
be surely determined in every individual case. When the 
patient comes to the physician he is usually already ill, else 
he would not have come. The date of the entry of the 
infection must, therefore, in such instances, be established by 
inquiry directed to determining when he was in contact 
with some other person, sometimes with an animal, showing 
similar symptoms, or at least, similarly infected; or was 
otherwise exposed. In very many instances it will be discov¬ 
ered that the present patient was in contact with such a 
source of infection for several days, a week, or a month, 
before becoming ill himself, and it is then impossible to 
decide absolutely on what particular day the poison entered 
his body first. 

But now and then the opportunity arises to decide the 
date of infection absolutely, as when a well child visits for 
one day another child, who is sick, and then develops a 
similar attack later on. 

The date of infection then, determined as above, marks the 
beginning of a period during which the patient, although he 
has within him the germ or seed of the disease, which will 
later sprout up so to speak, is just as well as ever. 

The period of incubation, then, is the period between the 
date of infection and the date of the earliest symptoms. 
The patient is quite well during this period—is not, in fact, 
a patient yet, but only a potential patient. Indeed, he may 
never develop the disease at all. During this period of 
incubation, the potential patient, in some diseases, and 
despite the fact that he is not yet sick in any way, is infec- 


INFECTIOUS DISEASES 

tious; that is, he may give to others the disease germs he is 
carrying about with him. This is true of diphtheria, of 
typhoid fever, of cholera, and some others. But the potential 
patient, during the incubation period, is not infectious in 
other diseases—for instance, in small-pox, chicken-pox, 
measles, German measles, scarlet fever, the patient is, in the 
incubation period, harmless to others, and remains harmless 
all through the incubation period right up to the time when 
the first symptoms appear. 

The person infected with diphtheria, typhoid, cholera, but 
not yet sick (perhaps he may never become sick), is, and 
may a long time remain, infectious. Such persons are called 
carriers, which means well- persons who are infected, who 
can give the germs of disease they carry to others, yet 
are not sick, and may never, perhaps, become sick. Because 
they are infected they are dangerous: if they do not become 
sick they are doubly dangerous; for if they become sick, the 
presence of the infection may be recognized and they may 

be isolated, while if they do not become sick they may go 

on for days, weeks, months or years, infecting other people, 
but unrecognized as the source of the infection. 

Returning to the consideration of the ordinary course, we 
find that, marking the end of the normal incubation period, 
comes the date of earliest symptoms. The patient is now 
upset, feels sick. If he is seen at this early stage, all that 
usually can be certainly determined at once is that he is 

sick; what germ is responsible cannot yet be definitely 

settled from his symptoms because there is as yet usually 
no definite differentiation of the symptoms. He “is sicken¬ 
ing for” something, as the phrase goes, but for what is not 
yet usually determinable absolutely. Nearly every slight 
ailment due to infection, as well as nearly every serious 

one, begins in this way and cannot be differentiated with 

certainty at this stage from the symptoms alone. 

This date of first symptoms is also called, for obvious 

reasons, the date of onset. The patient is infectious at this 
stage in almost all our infectious diseases. In diphtheria, 

typhoid, cholera, he has been infectious from the earlier 
date of infection, but in many of the other diseases of this 
part of the world, the infectiousness begins at this date of 
onset. When a patient of this latter group becomes sick 
and is promptly isolated, the damage he has done in infect¬ 
ing others is confined to what he has done since he became 
sick, an interval which can be reduced by watchfulness and 
prompt isolation to a few hours, or, at most, a day. But 
in the former group, since the patients are infectious during 
the whole of the incubation period and are also well during 
this period, the damage they may do before becoming sick is 


INFECTIOUS DISEASES 


the damage done during days or even weeks of infectious* 
ness preceding any possible recognition of their condition as 
being dangerous at all, so far as symptoms go. 

This date of earliest symptoms, or date of onset, ends the 
incubation period and ushers in a new period, the period of 
prodromal symptoms, or more shortly, of prodomes; that is, 
of symptoms preceding the fully developed, fully recognizable, 
fully differentiated disease. 

The prodromal period ends with the development of some 
striking symptom, typical of the particular disease from which 
the patient is suffering. This typical symptom is a rash in 
measles, German measles, scarlet fever; a membrane in 
diphtheria; a swelling of the face in mumps; an eruption in 
smallpox and chicken pox, and so on. 

Between, then, the date of onset and the date of the ap¬ 
pearance of the typical symptoms we have a period of pro¬ 
dromes, in which the initial fever, headache, digestive upset, 
general feeling of sickness, more or less common to all 
these infections, grow worse. The length of the prodromal 
period is itself one of the best differential signs because the 
prodromal periods vary for each disease, just as the incuba¬ 
tion periods do. 

When the typical symptom has appeared—the eruption, 
rash, or whatever it may be—the disease passes into the 
third period or fastigium. This is the stage that the general 
public recognizes. 

The fastigium or fastigial period begins with the appear¬ 
ance of the typical symptom. It continues to the begin¬ 
ning of convalescence—a date which in some diseases is sharp 
cut and definite, as in pneumonia, where the temperature 
may drop from 104 degrees to normal in 24 hours; but which 
in other diseases is a shadowy period rather than a date. 

The period of the fastigium is in most diseases an infec¬ 
tious period—and in most diseases it was the only period 
recognized as infectious until quite recent years. The length 
of this period varies a good deal. Convalescence may be 
delayed by complications, relapses, etc. Yet in general the 
fastigial period has a more or less definite length in each 
disease; about one week in diphtheria, about three weeks in 
typhoid fever, and so on. 

The date of the beginning of convalescence ushers in the 
convalescent period, which ends with the date of complete 
recovery—a date somewhat indefinite, of course, and yet 
which can be fixed approximately from temperature and 
other records. This period of convalescence is very variable 
in different diseases and is by no means constant in any 
disease. Infectiousness continues during convalescence in 


INFECTIOUS DISEASES 


almost all diseases. It is a peculiarly dangerous period 
because the stress and strain of the fastigial period is relaxed, 
the patient is able to “sit up and take notice,” he feels 
lonely and wants to see friends and relatives, who are them¬ 
selves anxious to see the patient, to kiss the patient, condole 
with him, etc. Moreover, the improvement in the patient’s 
physical condition is usually construed subconsciously to 
mean a lessening of the danger of infection from him. But 
this idea is just as mistaken as is the idea that the pro¬ 
dromal period is not dangerous. 

It is obvious that the convalescent period is the converse 
of the prodromal period; the patient is growing better, rather 
than worse, the disease is lessening, not increasing. But 
this does not affect the question of infection. There are 
few exceptions to the rule that the patient is infectious from 
the moment the very first symptom of the disease has 
appeared up to the moment when the very last symptom has 
disappeared. 

But even on complete cessation of the symptoms, the 
history of the disease in that patient is not necessarily 
complete. This is particularly true of diphtheria, typhoid 
fever and cholera. Preceding the appearance of the earliest 
symptom was the incubation period, during which the germs 
introduced at the date of infection were increasing in number, 
this increase resulting in the appearance of the first symp¬ 
tom itself. The potential patient is well but infectious. 

But now following the disappearance of the last symptom, 
we have a converse period, in which the germs are decreasing 
in number, this decrease ending normally with their final 
complete disappearance. Matching the term given the first 
stage, incubation, indicating an increase of the germs, Hill 
has suggested for this last stage, the term decubation, 
indicating a decrease in the germs. Matching the term, 
infection, for the first entry of the germs, he has suggested 
the term, defection, for their final exit. 

The decubation period then extends from the date of final 
recovery of the patient to the date of final exit of the germs 
from the body—from complete recovery to defection. 

The patient is well during this decubation stage, just as 
he is in the incubation stage. Moreover, just as he is 
infectious in some diseases during incubation, notably in 
typhoid, diphtheria and cholera so he is infectious during 
decubation in the same diseases. Just as he is noninfectious 
during incubation in many other diseases, so he is noninfec¬ 
tious during decubation in these other diseases. 

How long is the decubation period? While there are, no 
doubt, certain average lengths for each disease, yet we 


INFLAMMATION OF BREAST 


know also that the decubation period varies even in the 
same disease very much. Thus in diphtheria it probably 
averages about two weeks; yet it has been prolonged to 
nineteen months, and it is not infrequently six to ten 
weeks long. In typhoid fever the average decubation period 
is probably a month, but there is on record at least one 
case in which it lasted 54 years. 

Just as persons who, never having had the disease, may 
become infected and so enter the incubation stage, but may 
never develop the earliest symptoms, remaining infectious, 
nevertheless, for shorter or longer periods, or even for 
their whole remaining lives, so persons who have had the 
disease and have recovered from it, thus going into the 
decubation stage, may never reach defection—i. e., the germ 
may continue in their bodies and render them infectious 
for long periods or even for the rest of their lives. 

The patient who has recovered entirely from an attack of 
an infectious disease is, to all appearance, just the same 
individual as he was before, whether he continues infectious 
or not. But really he is profoundly different. One of the 
ways in which he may be different has just been outlined— 
if he remains infectious after recovery, he is now a menace 
to all nonimmune associates, as he was not, before he had 
the disease. But whether he is infectious or not, the 
recovered patient is almost always different in another way 
—lie cannot again suffer (for a time at least) from the same 
disease. In brief, the attack has more or less immunized 
him to similar attacks. The immunity may be lifelong, as in 
smallpox, or only a few months long, as in diphtheria; and 
actual tests can demonstrate the presence of the protective 
agent in the blood in some diseases, notably in diphtheria. 
This immunity to an infectious disease is as specific as the 
germ. No disease immunizes the patient against any other 
disease, but only against itself. Thus, scarlet fever im¬ 
munizes only against scarlet fever, diphtheria only against 
diphtheria, real measles only against real measles, and 
so on. 


INFLAMMATION OF BREAST 

See Mastitis. 


INFUSIONS 

Infusions are preparations of plant drugs made by pouring 
hot or cold water over them, and then allowing the drug 
to steep. The strength of an infusion depends on the quan¬ 
tity of drug used to a definite amount of water. 


INSANITY 


INSANITY, CLASSIFICATION 
I, Organic Group 

Senile psychoses. 

Psychoses with cerebral arteriosclerosis, or with syphilis. 

General paralysis. 

Psychoses with trauma; with brain tumor, Huntington’s 
chorea or other diseases. 

II. Toxic Group 

Intoxication psychoses due to alcohol and drugs. 

Autotoxic psychoses. 

III. Somatic Disease Group 

Infective psychoses; and exhaustive psychoses. 

IV. Constitutional Group 

Manic-depressive psychoses. 

Involution melancholia. 

Dementia praecox. 

Paranoia. 

Epilepsy. 

Psychoneuroses. 

Mental deficiency. 

INSANITY, LEGAL ASPECTS 

Insanity, meaning “unsoundness,” is a term applied by the 
courts of law to conditions of mental derangement, and has 
been adopted generally to include all forms of mental illness. 
It is, therefore, a legal and social term and not a medical 
one. From the medical standpoint no definition of insanity 
is possible, for a person mentally ill may be entirely com¬ 
petent according to the Statutes which provide that the test 
of competency is the person’s fitness to attend to the ordi¬ 
nary common affairs of life. The mental activity may be 
perverted or disordered in only one particular field, or lim¬ 
ited to a single subject as shown by the impulse to do cer¬ 
tain acts or by a particular delusion, and at the same time 
the patient may be Quite capable of transacting business 
and be rational in all other ways. 

It is only when mental disease disables socially, when the 
individual is unable to adequately cope with his environ¬ 
ment and is incapable of making the ordinary adjustments 
in domestic, social and business relations, or commits an 
illegal act that the question of insanity is raised and his re¬ 
sponsibility must be determined. 

Responsibility has been held by the courts to mean that 
“the person is able beyond doubt to comprehend the nature 


INSOLATION 


and consequences of his acts, and has sufficient power of will 
to overcome impulses to commit crime.” 


See Sunstroke. 


INSOLATION 

INSULIN 


Insulin is a specially prepared and standardized extract of 
pancreas containing an internal secretion from the islands of 
Langerhans. It is being used in cases of diabetes mellitus, to 
aid the carbohydrate metabolism, and also to prevent diabetic 
coma. It must be used in combination with the dietetic 
regime, and is given by subcutaneous injection. 


INTERTRIGO 

See Skin Diseases. 


INTESTINAL OBSTRUCTION 

This is a condition in which the normal passage through 
the intestinal tract is interfered with, either partially or com¬ 
pletely. The symptoms naturally will vary according to the 
locality of the obstruction. If it is high up, near the duo¬ 
denum, vomiting is an early symptom; if low in tiie ileum, 
distention is more marked. 

Treatment. —Immediately after a diagnosis of intestinal 
obstruction, an exploratory celiotomy is performed with the 
hope of finding the cause of the obstruction and relieving it. 

Ante-operative Treatment. —In all cases of intestinal ob¬ 
struction it is very essential that the stomach be washed just 
before giving the anesthetic. This will save a great deal of 
annoyance later, because the danger of aspirating the foul 
materials stored in the stomach is reduced to the minimum. 
If the patient is very weak or greatly shocked it is advisable 
to administer the clysis of saline either before the operation 
or at the time the operation is being performed. 

Operation.—Inasmuch as the actual surgical conditions in 
most cases of intestinal obstruction are not diagnosed until 
the operation, the operating room nurse should be ready 
at a moment’s notice for anything from an enterostomy to an 
extensive resection. Since these operations demand a com¬ 
plete exploration, there should always be on hand plenty of 
pads and hot saline to care for the intestines as they are 
brought out from the peritoneal cavity. If, after the obstruc¬ 
tive element has been found and removed, the distention is 
still great to the point of paralysis of the smooth muscle of 
the intestine, an enterostomy might be performed. This is 
an incision into the bowel for the purpose of inserting 
therein an L-shaped glass tube known as a Paul’s tube, or 
a simple rubber one. The open end of the glass is con¬ 
nected with rubber tubing which drains into a bottle pro- 


INTESTINES, DISEASES OF 

vided for the escape of the intestinal contents. This opera¬ 
tion practically amounts to the formation of an artificial anus. 

Post-operative Treatment. —If an enterostomy has been 
done, the treatment is the same as that prescribed following 
intestinal injuries. If the tube has been placed in a high 
portion of the jejunum, peptonized milk, beaten egg and 
other nutritive fluids may be introduced through it via a 
catheter entering the descending loop of gut; the original 
enterostomy tube should be temporarily clamped after the 
feeding has been introduced. It is very important that 
these cases should be given plenty of fluid either hypo¬ 
dermically, rectally, or by infusion. The skin about the 
enterostomy opening should be well protected against the 
irritating influences of the intestinal contents either by 
albolinated gauze or Beck’s paste. 

INTESTINES, NURSING IN DISEASES OF 

Recognize the fact that intestinal disorders are apt to be 
accompanied by mental depression, and make the counter¬ 
acting of this one of your objective points. Use your 
knowledge of food values and metabolic requirement and 
with keen realization of the intestinal weakness of the tract 
on which you are working; select the foods which will 
harbor, not overtax, its strength. Watch all excreta for 
clues. Remember that the care of the teeth and the tongue 
are important details. Encourage the kidneys to assist in 

cleansing system by giving plenty of water to drink unless 
fluids are restricted; but never give ice water. 

Visualize the intestinal anatomy and be certain that 
external applications cover exactly the point you intend to 
treat and that they are held in the correct position as shall, 
with the least discomfort to your patient, bring the result 
for which you are working. 

External applications should be light in weight, kept uni¬ 
form in temperature, hot or cold as ordered, never luke¬ 
warm. After removing them, cover the skin with soft, 

warmed flannel to preserve the temperature that has been 
attained. 

Rectal and colonic treatment should be preceded by 

introducing a well lubricated tube for the liberation of gas. 
This will often prevent the expulsion of the solution to be 
retained, such as the stimulating or nutritive enemata, and 
lessen the pain of the further introduction of solutions. 
Lubricate your tubes well, expel air, introduce slowly and 
without force, allowing an even, gentle flow regulated by 

the height of your container above the buttocks. 

Remember your object in giving the treatment:—if it is for 
continuous heat, watch the temperature of the water, and 


INTESTINES, SURGICAL CONDITIONS OF 

conserve your patient’s strength, so that you may continue 
the treatment until you have the desired result; if it is for 
nourishment, mix so carefully and administer so slowly that 
you accomplish the thing your patient needs. 

Make your notes of value by observing and charting every 
detail accurately and concisely. 

INTESTINES, SURGICAL CONDITIONS OF 
There are many diseases affecting the intestines but the 
interesting ones from a surgical standpoint are those result¬ 
ing in perforations and new growths. The intestines may 
be the seat of perforation as the result of typhoid, or 



c 


Types of intestinal anastomoses. A, end to end; B, side to 
side; C, end to side; D, end to end by Murphy button. 

(From Colp and Keller’s Text-book of Surgical Nursing) 

tuberculous ulcers, or they may be torn by some traumatic 
condition resulting from a stab or bullet wound. The 
symptoms are those of peritonitis. The operation at first 
is in the nature of an exploratory laparotomy. A search 
is made for the injured intestine and when found the 
wound, if small, is closed by a purse-string suture. If the 
wounds are multiple, it may be necessary that that part of 
the intestine be resected, and the two open ends of the gut 
which have resulted may then be joined together by what 
is known as an end-to-end, end-to-side, or side-to-side 
anastomosis (Figs. A, B, & C). Resection is also employed 
in conditions of intestinal growths, either benign or malig¬ 
nant. 





INTRAVENOUS ADMINISTRATION OF MEDICINES 

If the condition of the patient is too poor to warrant 
the time necessary to anastomose the intestines with suture, 
a Murphy button may be employed (Fig. D). This is a 
perforated metal button consisting of two halves. One half 
is introduced into one open end of the intestine and the 
intestine drawn over it by suture. The other half is inserted 
into the other open end of the gut. The two parts of the 
button are then locked together, thus anastomosing the 
walls of the intestine. The button eventually passes along 
the intestine after the union between the bowel segments 
has become firm. 

Post-operative Treatment. —Operations upon the intestines 
require the same care practically as that following operations 
upon the stomach, except that cathartics by mouth should 
not be given too early, and, when one is given, a mild 
cathartic rather than a severe purgative should be prescribed. 
While the patient should be kept free from pain, too much 
morphine should not be administered, for there is always 
danger of intestinal paresis due to over dosage of this 
powerful hypnotic. Should the patient become distended, an 
irritative enema should be administered, and after the fourth 
day, colon irrigations may be employed without any danger. 
If a Murphy button has been used for anastomosis, all stools 
should be examined for the presence of the button, and its 
passage should be immediately reported. 

INTRAMUSCULAR ADMINISTRATION OF MEDICINES 

The site for an intramuscular injection is usually one of 
the buttocks, or the front of one of the thighs. The skin 
over the site of injection is sterilized in the usual manner. 
A sterilized hypodermic syringe is filled with a well diluted 
solution of the drug to be injected and fitted with a large 
firm needle. The needle is then inserted perpendicularly 
into the muscles. The syringe may now be withdrawn or 
slightly aspirated. If blood is obtained a new site must 
be chosen as the needle has probably been stuck into a vein. 
If no blood is obtained the solution may be injected, but 
very slowly; and the area of injection should then be 
thoroughly massaged and covered with a little collodion 
or some other dressing. 

INTRAVENOUS ADMINISTRATION OF MEDICINES 

Intravenous Injection. —The median basilic or median 
cephalic vein of the front of the elbow is the most suitable 
vein for injecting drugs. A rubber or gauze bandage is 
tightly wound around the middle of the arm and the hand 
is gripped firmly while the forearm is extended. The vein 
is thus made to stand out prominently. The surface of the 


INTRAVENOUS INFUSION 


skin over the vein is then sterilized with green soap, 50 
per cent, alcohol and a 1:20oo bichloride of mercury, or 
the site may be painted with tincture of iodine. 

A sterilized hypodermic syringe is now filled with a sterile 
solution of the drug to be injected, and the air expelled 
from the syringe. The needle is then inserted into the vein 
pointing it toward the heart and a few drops of blood 
slightly withdrawn from the vein. When blood enters the 
syringe you are sure the needle is in the vein. 

The bandage of the arm may now be loosened and the 
solution of the drug should be injected very slowly. Slow 
injection is very important, as serious, even fatal results 
have occurred from too rapid injection. 

INTRAVENOUS INFUSION 

An intravenous infusion or injection consists in the intro¬ 
duction of a solution into a vein. 

Conditions in which an Infusion is most Commonly 
Given. — 1. In hemorrhage to restore immediately the volume 
of blood to normal, and to maintain the normal blood-pres¬ 
sure. 

2. In shock and collapse to stimulate the circulation. 

3. In postoperative conditions or in diseases such as cholera 
to restore the volume of blood and supply fluid to the tissues 
depleted by vomiting, purging and perspiration, etc. 

4. In toxemia to dilute the poisons, to flush the kidneys 
and carry away the poisons. 

In severe shock or collapse sometimes small amounts of a 
solution containing adrenalin are given. Adrenalin contracts 
the blood vessels and raises the blood-pressure. 

The effects of an intravenous infusion will depend upon 
whether the volume of blood has previously been decreased 
or not. 

1. When the volume has been reduced by a severe hemor¬ 
rhage, by persistent vomiting or excessive purging, etc., the 
effect is to increase the volume of blood, raise the blood 
pressure, and stimulate the heart and circulation. 

2. When the volume of blood has not been decreased by 
hemorrhage, etc., a saline infusion has little, if any, effect 
on the blood-pressure. 

The solutions used are: 1. Normal salt solution. —This 
contains 0.9 per cent, of sodium chloride. Even slight 
variations from this strength may be dangerous. 

2. Locke’s Solution .—This contains sodium chloride 0.9 
gm.; potassium chloride, 0.042 gm.; calcium chloride, 0.024 
gm.; sodium bicarbonate 0.03 gm.; dextrose 0.1 gm., and 
distilled water sufficient to make 100 c.c. This is the best 
solution because it contains the necessary salts and is 


INTRAVENOUS INFUSION 


alkaline and nutritive. It, therefore, supplants blood which 
may have been lost (or withdrawn because impure) and it 
supports the heart. 

In diabetic coma, a 4 per cent, solution of bicarbonate of 
soda is sometimes given intravenously to neutralize the 
acidity or to increase the alkalinity of the blood and thus 
relieve the acidosis to which the coma is due. 

In the very emaciated, in pneumonia, in gastric ulcer, 
carcinoma, and operations on the alimentary tract a 10 per 
cent, glucose solution is sometimes given intravenously to 
supply the tissues with nourishment in a form that can be 
quickly utilized to produce heat or energy. 

There is danger of injury to the vein followed by 
phlebitis with thrombus formation and embolism, the intro¬ 
duction of bacteria causing septicemia, and of the introduc¬ 
tion of air, and of foreign matter causing a very serious 
reaction endangering the life of the patient. 

The temperature of the solution should be from iio® to 
118 0 F., heat being a valuable stimulant. 

The amount of solution given will depend upon the con¬ 
dition of the patient, the purpose for which the treatment 
is given, or the effect desired. In some cases 200 to 500 c.c. 
may be given and, again, from one to five pints may be 
slowly introduced, according to the necessities of the case. 
(Brewer.) 

The Procedure. —Preparation of the Patient .—The veins 
into which the injection is given are the median cephalic or 
the median basilic, in front of the elbow, which is usually 
the largest, the most prominent and nearest to the surface. To 
prepare the part the following articles will be needed: a 
dressing rubber to put under the arm to protect the bed, 
sterile towels to cover the rubber and the immediate area 
around the elbow, a tourniquet (to apply around the upper 
arm to shut off the return of blood by the superficial veins 
making the veins at the elbow prominent), and disinfectants 
to sterilize the skin. When applying the unsterile tourniquet 
see that the loose ends are directed upward so that they 
will not be in the way or contaminate the area or any sterile 
article. A good light is also absolutely essential. 

The instruments and utensils needed will depend upon 
the method used. The solution may be poured from a grad¬ 
uated glass into a glass funnel connected by rubber tubing, 
etc., to the infusion needle or it may be made to flow by 
gravity or siphonage directly from a glass flask through the 
rubber tubing, connecting tip and needle, etc., into the vein. 
The latter method is described under “Hypodermoclysis.” 

When the first method is used the articles required will 
be the glass graduate containing the solution and a sterile 


INTUSSUSCEPTION 


thermometer to test the temperature, a glass funnel, rubber 
tubing with a small metal connecting tip on the end to fit 
into the needle and having a glass connection in the rubber 
tubing through which air bubbles in the solution may be 
detected, also a clamp to shut off the flow, infusion needles, 
sterile cotton pledgets, a paper bag and basin for soiled 
pledgets or instruments, a sterile dressing and adhesive or 
bandage to retain it. If the arm is fat, the veins embedded 
or collapsed, it may be necessary to incise the skin and 
expose the vein. For this will be needed, in addition, a 
hypodermic loaded with cocaine 2 per cent., a scalpel, an 
aneurysm needle, artery clamps, catgut, probe, scissors, needle 
holder, dressing forceps, suture silk and needles. 

Method of Procedure. —After the needle is inserted in the 
vein, the tourniquet is loosened. Air is expelled from the 
tubing and while fluid is running the tubing is attached to the 
needle. The injection must be given very slowly, the funnel 
being held from one to three feet above the head. Dr. 
Hare advises one foot above the arm and states that at 
least thirty minutes should be used in injecting" as much as a 
quart.' Where a flask is used (second method) the nurse 
must see that the solution does not drop low enough to 
allow air bubbles to enter the tubing, and that the tempera¬ 
ture of the solution is maintained by adding, if necessary, 
hot solution. She should also watch the patient’s color, 
pulse, and breathing, and keep a record of the amount of 
solution given. 

The procedure is conducted under the most sterile aseptic 
precautions. The doctor wears gloves, and everything, except 
the dressing rubber and tourniquet, must be sterile. 

This treatment is contraindicated when edema is present. 

It is indicated when rapid action is desired, when the 
circulation is poor, and when the tissues are unable to absorb 
fluid. When this is not the case the same effects may 
ultimately be secured either by giving the injection into 
the tissues (hypodermoclysis), or into the rectum (procto¬ 
clysis). Effects by hypodermoclysis are “Secured more rapidly 
and directly than by proctoclysis. 


INTUSSUSCEPTION 

This condition is a form of intestinal obstruction brought 
about by the telescoping of one portion of the bowel into 
the other. The treatment, as a rule, is operative entailing 
a reduction of the intussusception, or if the bowel is gan¬ 
grenous, a resection of the involved portions. There is 
nothing special in its nursing. 

See Intestinal Obstruction. 


IODIDES 


INUNCTIONS 

Drugs are frequently given for absorption by rubbing on 
the skin. They are usually applied in the form of an oint¬ 
ment from which the drug is absorbed and produces its 
effects. The ointment must be rubbed over a large area of 
skin to get the greatest amount of absorption, and since the 
pores of the skin frequently get clogged up with it after 
constant use, a different region of the body should be used 
every day. Six successive daily rubbings on various parts 
of the body are called a “course.” The course is usually 
given in the following order: 

Each thigh, each arm, the chest, and finally the back. On 
the seventh day the patient should be given a bath to 
eliminate the drug and then the course is begun again. 

When administering potent remedies by means of rub¬ 
bings, the nurse should protect her hands by old kid gloves 
or by rubbing the ointment with a piece of chamois. Other¬ 
wise she may absorb it herself and get poisonous effects. 
The efficiency of the method depends largely on the vigor 
with which the ointment is rubbed and the extent of surface 
upon which the ointment is rubbed. 

IODIDES 

The iodides are salts formed by the action of an alkali, 
such as sodium, potassium or ammonium, on hydriodic acid, 
an acid formed from iodine. 

Appearance of the Patient 

After a single dose of one of the iodide salts is given, 
except for its slightly metallic salty taste, a slight burning 
pain in the stomach, and perhaps some slight nausea for a 
few minutes, there are no appreciable effects. 

If the iodides are given continuously for some time, how¬ 
ever, the secretions are all increased, the pulse is somewhat 
faster and softer, the patient passes more urine and feels 
much better. 

Prolonged administration of the iodides to a patient suf¬ 
fering from any manifestation of syphilis, especially -any 
symptoms of the third stage, causes a gradual disappearance 
of these symptoms, and in a very short time the patient feels 
entirely well again. 

Local action. The iodides produce no local effect when 
applied on the skin or mucous membranes, but they are 
rapidly absorbed into the blood from all mucous membranes. 

In the mouth: The iodides have a characteristic salty 
metallic taste. 

In the stomach: They slightly increase the secretions, 


IODIDES 


and occasionally cause nausea, and slight discomfort. The 
intestines are not usually affected by the iodides. 

The iodides cure the third stage of syphilis, by causing 
the absorption of newly formed areas of round cells, or 
gummata, which cause the various symptoms. They also 
probably destroy the spirochetal which cause the disease. 

Action on the secretions: The iodides increase the secre¬ 
tions of all the mucous membranes and secretory glands. 

Action on the Thyroid Gland: Iodine is a normal constit¬ 
uent of the thyroid gland and is necessary for the formation 
of its secretion. By providing this gland with more iodine 
its secretions are increased. As a result, it makes the 
pulse somewhat more rapid, and lowers the blood pressure. 

Action on nutrition: They increase the nutrition of the 
tissues and hasten the excretion of waste products. 

Effect on newly formed connective tissues: The iodides 
increase the absorption of newly formed connective tissue. 
They are used to absorb old scar tissue in any organ of 
the body. They are frequently used for this effect in 
arteriosclerosis (hardening of the arteries), cirrhosis of the 
liver, etc. 

Newly formed connective tissue cells are small round 
cells which resemble the round cells found in gummata. 
These cells may therefore be affected by the iodides in the 
same way as the gummata or round cell formations of the 
third stage of syphilis or as a result of the increased secre¬ 
tion of the thyroid gland. 

Accumulations of serum in the chest (pleurisy with 
effusion) or in other parts of the body, are more rapidly 
absorbed when iodides are given. 

Action on the circulation: Iodides do not usually affect 
the pulse. They occasionally lower the blood pressure when 
it is high and make the pulse somewhat more rapid. 

Action on the kidneys: The iodides slightly increase the 
flow of urine. 


Excretion 

The iodides are eliminated from the body by the urine, 
mainly as iodides, usually within twenty-four hours. 

Idiosyncrasies 

In some individuals small doses of the iodides often cause 
poisonous effects. 

Poisonous Effects 

The iodides do not cause acute poisoning. Since they 
are excreted more slowly than they are absorbed, after 
prolonged administration, chronic poisoning or iodism fre- 


IODIDES 


quently results from the accumulation of some of the drug 
in the body. These cumulative symptoms occasionally occur 
in some individuals from very small doses. 

The symptoms of iodism are due to the excretion of the 
iodine by the various mucous membranes, and they are 
not so apt to occur in syphilitic patients. 

Cumulative Symptoms or “Iodism’’ 

The first symptom of excessive iodide action is: 

Profuse secretion of mucus from the nose (coryza) and 
sneezing. 

These are soon followed by: 

2. Red, swollen eyelids with excessive flow of tears. 

3. Frontal headache. 

4. Cough, with profuse expectoration of mucus. 

5. Increased flow of saliva. 

6. Sore throat and difficulty in swallowing. 

7. Skin eruptions, such as areas of redness, or small 
pustules on the face, back, shoulders or thigh (acne). Occa¬ 
sionally eczema occurs. 

8. The pulse is often rapid and a slight rise in tempera¬ 
ture may occur. 

9. Nausea and diarrhea occasionally occur. 

10. Weakness, loss of weight, and pains in the joints 
occasionally result from continued use. 

Treatment. —When the iodides are stopped, the symptoms 
usually disappear. 

Uses 

The iodides are used principally: 

1. As a specific for the third stage of syphilis. In 

syphilis, the treatment must be continued for about three 
years; even if the patient has no symptoms, to eradicate all 
the poison from the body. 

2. They are also frequently used to absorb connective 
tissue in various chronic diseases characterized by the for¬ 
mation of connective tissue in various organs and tissues of 
the body. For example, in arteriosclerosis, cirrhosis of the 
liver, chronic nephritis. 

3. To increase the absorption of inflammatory swellings 
of the glands and other tissues, and to absorb fluids in the 
chest. 

4. To increase the secretions of the mucous membranes, 
such as those of the bronchi, the nose, etc. 

Administration 

The iodides are best given after meals, in milk, wine, 
aromatic spirits of ammonia, or the compound spirits of 
sarsaparilla, or cinnamon water, to disguise the unpleasant 
taste. They are occasionally given in pills or capsules. 


IODINE 


Preparations 

Potassium Iodide; dose 5 to 15 grains. In syphilis it may 

be given up to 60 grains. 

This is the most efficient and most commonly used prepa¬ 
ration. It often comes in 50 per cent, or saturated (100 
per cent.) solutions. 

Sodium Iodide; dose 2 to 20 grains. 

Ammonium Iodide; dose 2 to 15 grains. 

Strontium Iodide; dose 5 to 15 grains. 

Dilute Hydriodic Acid; dose 5 to 10 mini.ms. 

This contains 10 per cent, of hydriodic acid. 

Syrup of Hydriodic Acid (Syrupus Acidi Hydriodici); 
dose V2 to 2 drams. This contains 1 per cent, of hydriodic 
acid. 

For Local Use 

Potassium Iodide Ointment (Unguentum Potassii 
Iodidi). 

IODINE 

Iodine is a non-metallic element obtained from the ashes 
of sea weeds. Iodine itself is not used in medicine, but 
various solutions and compounds of it are frequently em¬ 
ployed. 

Antiseptic Action: Iodine checks the growth of bacteria, 
having a marked disinfectant action. It has been used 
very extensively for the last few years to disinfect the skin 
in preparation for operations. It is of special value for 
this purpose since it also contracts and hardens the skin 
so that bacteria cannot be carried from the skin to the 
deeper tissues of the wound. It should not be applied in a 
concentrated solution or when the skin is moist, as it is 
then apt to cause blisters or even to destroy the deeper 
tissues. 

Local action: Iodine stains the skin a dark brown color 
and makes it red and warm. Strong solutions cause blisters 
and may even destroy the skin. It is also slightly absorbed 
from the skin. 

On mucous membranes: It produces redness, smarting and 

increases the secretions. 

Internal Action: When taken internally, it causes nausea 
and occasionally vomiting and diarrhea.- It is readily absorbed 
from the stomach in a few minutes. 

Excretion: Iodine is eliminated from the body in a few 

minutes; by all the secretions as well as by the kidneys. 

Poisonous Effects 

Acute poisoning from iodine occurs very rarely; usually 
from the injection of iodine into cysts in order to obliterate 


IODOFORM 


them, and occasionally from iodine taken with suicidal 
intent. 

Symptoms: i. Nausea and continuous vomiting. The 

vomited matter contains iodine which turns blue if starch 
is also present. 

2. Diarrhea. 

3. Cyanosis. 

4. Collapse, rapid thready pulse, cold moist skin, slow shal¬ 
low breathing and dilated pupils. Death usually occurs in a 
few days. 

Treatment: Give boiled starch as an antidote. Protect 

the mucous membrane with albumin water, milk or other 
protecting drinks; treat the collapse with heart stimulants; 
such as caffeine, atropine, strychnine, etc. 

Chronic Poisoning “Iodism”: Continued use of iodine 
often causes the following symptoms: 

1. Skin eruptions, beginning at the site of application; 
consisting of areas of redness. 

2. Increased secretion of mucus from the nose and bronchi. 

3. Rapid pulse. 

4. Nervousness and tremors of the fingers. 

The symptoms usually disappear when the iodine applica¬ 
tions are stopped. 

Preparations 

Tincture of Iodine; dose 3 to 8 minims. 

This contains 7 per cent, of iodine and 5 per cent, of 
potassium iodide in alcohol. 

Compound Iodine Solution (Lugol’s Solution); dose 3 to 
12 minims. 

This contains 5 per cent, of iodine dissolved in 10 per cent, 
of potassium iodide solution. 

Iodine Ointment 

This contains 4 per cent, of iodine. 

Sulphur Iodide 

This is a mixture of iodine and sulphur. 

IODISM 

See Iodides, Iodine. 

IODOFORM 

Iodoform is a yellow crystalline powder which has a very 
characteristic odor and a sweet taste. It contains about 
97 per cent, of iodine. 

Local action: Applied to the skin, to wounds or mucous 
membranes, iodoform acts as a mild antiseptic and disinfect¬ 
ant. It absorbs the fluids from the wound and in this way 
it prevents the growth of bacteria. Iodoform is very 
soothing to the skin or mucous membranes. 


IPECAC 


Poisonous Effects 

Iodoform is often absorbed into the blood from wounds or 
sinuses, especially when the surface of the wound is very 
extensive. This is more apt to occur in adults or susceptible 
individuals. It produces the following characteristic poison¬ 
ous symptoms. 

1. In mild cases there may be only a rise of tempera¬ 
ture; 104° to 105° F. Headache, dizziness, very rapid pulse 
and loss of appetite, also occasionally occur. 

In severe cases the following symptoms may also occur: 

2. The patient feels depressed, downhearted, even melan¬ 
choly. 

3. Hallucinations (ideas of being persecuted and attempts 
at suicide). 

4. Delirium, even mania. 

5. Collapse, which may cause death. 

The symptoms may last for several hours or days. Occa¬ 
sionally there is no excitement, the patient goes into stupor 
and dies of collapse. 

The dose of iodoform is Yl to 3 grains. 

Iodoform is used principally externally in wounds and 
sinuses in the form of Iodoform gauze. 

Iodoform gauze is made by soaking sterile gauze in a 
solution containing 5 to 10 per cent, of Iodoform, 20 to 
15 per cent of glycerin and adding alcohol up to 100 c.c. 

Iodoform Ointment contains 10 per cent, of iodoform. 

IPECAC 

Ipecac is a drug obtained from the roots of the Cephaelis 
ipecacuanha, a wild plant growing in Brazil, Colombia and 
other parts of South America. 

Its active principles are the alkaloids: Emetine and 
Cephaeline. 

The vomiting is due principally to the cephaeline and 
partly to the emetine. 

Appearance of the Patient 

If a patient is given a moderately large dose of one of 
the preparations of ipecac, a very short time after the admin¬ 
istration he feels nauseated and vomits profusely. The 
vomiting is usually accompanied by profuse secretion of 
saliva, of tears, and of mucus from the bronchi. Occa¬ 
sionally, if the entire amount of drug is not completely 
excreted in the vomited matter, it may cause profuse diar¬ 
rhea and symptoms of mild collapse: rapid pulse, slower 
respiration, and cold moist skin. 

Local Action: On the skin ipecac produces redness, itch¬ 
ing and small pustules. 


IPECAC 


On the mucous membranes: On the eye it causes slight 
redness and swelling with a profuse flow of tears. In the 
nose it causes profuse secretion and continual sneezing. 

Internal Action: In the mouth: It increases the flow 
of saliva. 

In the stomach: Ipecac acts principally on the lining 
membrane of the stomach, causing redness and swelling with 
an excessive secretion. This causes the muscle wall of the 
stomach to contract violently, thereby producing vomiting. 
The vomiting continues, until all the ipecac in the stomach 
is entirely expelled. 

In the intestines: The action on the intestinal tract is 
similar to that in the stomach; the lining membrane becomes 
red, swollen and secretes an excessive amount of mucus, 
thereby producing contractions of the muscle wall of the 
intestines which result in profuse diarrhea. The stools often 
contain blood, from the excessive irritation. 

Action after Absorption. —Some of the ipecac is rapidly 
absorbed from the stomach. It then acts principally on all 
the mucous membranes. On the mucous membrane of the 
bronchi, it causes a profuse secretion of mucus. (It is com¬ 
monly given in cough mixtures for this effect, especially to 
children, to increase expectoration.) 

The symptoms of collapse, which occasionally result after 
large doses of ipecac, are usually due to the great strain of 
continual vomiting. 


Specific Action 

Ipecac is now used as a specific for Amebic Dysentery 
and in Pyorrhoea alveolaris. The effect is due to the emetine, 
which destroys the ameba. 

For its specific action ipecac should be given in keratin 
coated pills so as to avoid its action on the stomach and 
thereby to prevent vomiting. 

Excretion 

Ipecac is usually excreted by the stomach in the vomited 
matter, and does not therefore produce any poisonous symp¬ 
toms. 


Preparations 

Powdered Ipecac, as emetic; dose 30 grains; as expecto¬ 
rant; dose 1 to 5 grains. 

Powdered Ipecac and Opium (Dover’s powder); dose 5 to 
15 grains. (Contains 10 per cent, opium and 10 per cent, 
ipecac.) 

Fluidextract of Ipecac, as emetic; dose 15 to 30 minims; 
as expectorant; dose 3 to 8 minims. 


IRON 


The following two preparations are given mostly to chil¬ 
dren. 

Syrup of Ipecac, for infant as emetic; dose 30 to 60 
minims; (7 per cent, of fluidextract) as expectorant; dose 2 
to 15 minims. 

Wine of Ipecac; for a child as emetic; dose 30 to 60 
minims; (10 per cent, of fluidextract) as expectorant; dose 
2 to 15 minims. 

Emetine Hydrochloride; dose % to 1 grain. 

This has recently been used with brilliant results in the 
treatment of amebic dysentery. It is given hypodermically 
in small doses and by mouth in the maximum dose. 

Administration 

If given to produce vomiting, it is best to dilute ipecac 
preparations in warm water. 

If given as an expectorant, especially to croupy children, 
the preparations should be given in syrup. 

IRON (FERRUM) 

Iron is a heavy metal; many of its preparations are used 
as drugs. Many food substances, such as meat, eggs and some 
vegetables, contain a great deal of iron. In the body, 
iron is found principally in the hemoglobin of the blood. 

Local Action: On the skin, iron causes no effect, but if 
it is applied to a bleeding surface, it stops the bleeding, by 
precipitating the albumins of the blood, which then close 
up the bleeding vessel. Mucous membranes are contracted 
by preparations of iron (astringent action). 

Internal Action 

In the mouth: Iron has a distinct metallic taste, and 
shrinks the lining membrane of the mouth, making it feel 
dry. It also discolors the teeth, if used continually. 

In the stomach: It contracts the lining membrane and 
occasionally causes nausea. 

In the intestine: It contracts the lining membrane, 
checking the secretions, thereby producing constipation. 

Action after Absorption 

If iron is taken for any length of time the red blood 
corpuscles of the blood contain more hemoglobin. The 
contractions of the heart are improved; the patient is able 
to breathe deeper, and thus inhales more air; the food is 
digested better; the muscles contract better; the brain acts 
better, the patient is brighter, is more in harmony with his 
surroundings, and all the organs of excretion, such as the 
kidneys, the lungs and skin, eliminate waste products better 
and quicker. 


IRON 


Appearance of the Patient 

As a result of the improved activity of all the organs of 
the body, the patient feels brighter, is more active, and 
more robust. He looks better, has a ruddier color, his appe¬ 
tite is better, and he digests his food better. 

The effects do not appear after a few doses, but result 
from continued administration of iron. 

Excretion 

Only part of the iron taken as a medicine, or in the food, 
is absorbed. The rest is excreted by the intestines, in the 
stools. On account of the large amount of iron present 
in the stools, the lining membrane of the intestines is con¬ 
tracted, and constipation results. 

Uses 

Iron is used principally in cases of anemia, a condition 
in which the patient’s blood is very poor. For example— 
when the patient has lost a great deal of blood, or when he 
is suffering from some chronic disease, such as tuberculosis 
or cancer. It is used with best results in a peculiar kind of 
anemia, occurring in young girls, called chlorosis. 

Poisonous Effects 

In some cases, after continued use of iron for any length 
of time, it produces the following symptoms: frontal head¬ 
ache, loss of appetite, pain in the pit of the stomach, occa¬ 
sionally nausea and vomiting, colic and invariably constipa¬ 
tion. Sometimes the skin becomes covered with very small 
pustules (acne). 

The condition is relieved by stopping the iron, and giving 
cathartics. 

Administration 

In giving iron, the nurse should remember the following 
rules: 

1. Iron should always be given after meals, well diluted, 
in an albuminous fluid such as milk. 

2. To avoid discoloring the teeth, iron should always be 
given through a glass tube or a straw, so that the drug 
does not touch the teeth. 

3. To avoid constipation, the bowels should be moved 
regularly with some cathartic, or a preparation of iron 
should be given which contains a cathartic. 

4. If a gargle containing iron is given, the teeth should 
be brushed and the mouth then rinsed with salt water after 
each administration. 

5. Silver spoons are stained by iron; they should never 
be used in giving any of the preparations. Strong ammonia 
water removes these stains. 


IRON 


6. Iron stains clothing, sheets, carpets, etc. Oxalic acid 
removes these stains. 


Preparations 

There are a great many preparations of iron, but only the 
most important ones follow: 

There are several preparations of iron which are only 
used for their local effects or to check bleeding. 

For internal use there are two kinds of preparations: 
inorganic and organic. 

The inorganic preparations are metallic salts of iron. 

The organic preparations are preparations of iron com¬ 
bined with various kinds of proteins, such as egg albumin. 

The organic preparations do not contract mucous mem¬ 
branes as much as the inorganic ones; and are, therefore, not 
so apt to cause unpleasant symptoms after continued use. 

Preparations for Local Use 

Solution of Iron Subsulphate (Monsell’s solution); dose 
3 to io minims. 

This preparation contains about 13 per cent, of iron. 

Iron Chloride 

This preparation is used in a 20 per cent, solution. 

These two preparations are principally used to stop bleed¬ 
ing or to contract mucous membranes, either by local applica¬ 
tion, or in the mouth as a gargle. 

, Iron Sulphate (Green vitriol); dose % to 5 grains. 

This is seldom used internally, but it is used to contract 
mucous membranes and check bleeding. It is also used as a 
disinfectant for privies or drains. 

Preparations for Intomal Use 

Pills of Iron Carbonate (Blaud’s pills); dose 1 to 5 pills. 

These pills consist of iron sulphate, the carbonate of 
sodium or potassium, tragacanth, sugar and glycerin. 

Each pill contains about 1 grain of iron. 

These pills should always be fresh. Old pills may pass 
through the intestines without causing any effects, or with¬ 
out being changed in any way. 

Reduced Iron (Ferrum Reductum) ; dose 1 to 2 grains. 

This is a brown powder which is tasteless and does not 
contract mucous membranes. It is often given to children 
in candy. 

Soluble Iron Phosphate ; dose 1 to 5 grains. 

Iron Citrate; dose 1 to 5 grains. 

Solution of Iron Tersulphate 

This contains 10 per cent, of iron. 


IRON 


It is only used in making up other preparations, especially 
the antidote for arsenic. 

Tincture of Iron Chloride; dose 5 to 30 minims. 

This is one of the best preparations of iron, and is very 
frequently used It contains about 4 per cent, of iron in 
alcohol. 

It is best given in milk or in glycerin, 3 parts of the 
preparation to one of glycerin, (to prevent constipation) or 
in egg albumin, to prevent its blackening the teeth. 

Solution of Iron and Ammonium Acetate (Liquor Terri 
et Ammonii Acetatis) (Basham’s mixture); dose 4 to 8 
drams. 

This preparation contains very little iron and must be 
freshly made. It consists of tincture of iron chloride, dilute 
acetic acid, solution of ammonium acetate, elixir of orange, 
glycerin and water. 

Syrup of Iodide of Iron; dose 5 to 30 minims, well diluted. 

This is an excellent preparation especially for children. 
It contains about 2 per cent, of iron. 

Compound Iron Mixture (Mistura Ferri Composita) 

(Griffith’s mixture); dose 4 to 8 drams. 

This preparation contains iron sulphate, potassium car¬ 
bonate, myrrh, sugar and spirits of lavender. 

Elixir of Iron, Quinine and Strychnine Phosphate 

This preparation is very frequently used as a tonic. It 
contains about 2 per cent, of iron phosphate. 

Each teaspoonful dose contains 1/2 grain of iron phosphate 
and quinine and ^4 grain of strychnine. 

Syrup of Iron, Quinine and Strychnine Phosphate; dose 1 
to 2 drams. 

This preparation contains 9 per cent, of iron phosphate. 
Each teaspoonful dose contains 5 grains of iron phosphate, 
%0 grain strychnine and i 1 /? grains of quinine. 

Antidotes for Arsenic 

Iron Hydroxide 

This preparation is used principally as an antidote for 
arsenic poisoning. About 8 grains of it will neutralize 1 
grain of arsenic. It must always be fresh. 

If iron hydroxide is not on hand, it can be made from 
the tincture of iron chloride, by adding ammonia water or 
sodium carbonate to it. A precipitate (sediment) will then 
form. Enough ammonia or sodium carbonate must be 
added until no more sediment forms. The sediment is then 
washed and strained, and given in milk; as often as is 
necessary to neutralize the arsenic. 

Iron Hydroxide with Magnesium Oxide; dose 4 to 8 drams. 


IRRIGATION 


This is made from iron sulphate, to which magnesia is 
added. It is the best antidote for arsenic poisoning. 

Dialyzed Iron; dose 20 to 40 minims. 

This is a preparation of iron which is frequently used as 
an antidote for arsenic poisoning. It is also used in the 
treatment of anemia. 

Incompatibilities of Iron 

The following drugs cannot be given together with iron 
because they form chemical compounds with it: 

Preparations of iron should never be given with tea, or 
with vegetable drugs containing tannin or tannic acid, as iron 
combines with these drugs and forms ink. 

The alkaline preparations of iron should not be given 
with acids. For example—do not give Basham’s mixture 
together with dilute acids, as they combine and form a 
sediment. 

The iron salts of the mineral acids should not be given 
with alkalies. For example—do not give tincture of iron 
chloride with sodium bicarbonate, as they will combine and 
form a sediment. 


IRRIGATION 

See Bladder Irrigation; Colon Irrigation; and Rectum, 
Administration of Medicines by. 

ISCHIORECTAL ABSCESS 

An abscess about the rectum is like an abscess in any 
other part of the body except that it may communicate with 
the rectum, and if not treated properly a fistula may result. 
This is a tract connecting the skin and rectum. For this 
reason it is always better to incise and drain the abscess as 
soon as possible, packing the abscess cavity and permitting 
it to granulate from the bottom. 

Fistula in Ano. —This may be the result of a poorly treated 
ischio-rectal abscess. It is important in treating the fistula 
that the tract be incised in its entirety by careful and com¬ 
plete dissection. 

Ante-operative Treatment. —A cathartic is given twenty- 
four hours before operation, usually an ounce of castor oil. 
Four hours before operation, the lower bowels should be 
thoroughly washed with a warm soap-suds enema. At least 
three of these should be given. If the third return is not 
clear, more enemata should be administered until the rectum 
is absolutely cleansed. This rectal treatment should not be 
administered just prior to operation, because much of the 
liquid material is apt to be retained and the surgeon is 
hampered in his work by the escape of rectal fluid. Some 


ITCH MITE 


surgeons inject the fistulous tract with a solution of methylene 
blue, a dye which colors the tract making its ramifications 
evident. This may be done before or after the anesthesia has 
been begun. 

Operation. —Until the patient regains consciousness, the 
legs should be tied together. In operations about the 
rectum, retention of urine is apt to result and great care 
should be taken lest the bladder become distended. The 
diet should be constipating and to further constipate the 
patient a pill containing opium is given three times a day. 
The bowels should be moved upon the fourth day, and, after 
the movement, the parts washed with soap and warm water, 
and fresh packing introduced. The packing must be changed 
each time the bowels move, if stained with fecal material. 
The dressing of these cases is exceedingly important. If 
the packing of the cavity is left to the nurse, she should 
very conscientiously see that it is firmly and securely 
introduced into the depths of the granulating cavity. The 
proper healing will do much to prevent a recurrence of the 
fistula. 


ISOPRAL 

Isopral is a white crystalline substance, with an aromatic 
taste and an odor resembling camphor. It produces sleep 
in about five minutes after it is given. Its effects are similar 
to those of chloral, but it is not as poisonous. Dose, 3 to 8 
grains. 

ITCH 

See Lice. 

ITCH MITE 


See Lice. 


J 


JABORANDI 

See Pilocarpus. 

JALAP 

Jalap is the root of the Ipomoea jalapa; its active prin¬ 
ciple is a resinous substance, jalapin. It is one of the most 
commonly used drastic cathartics. 

Preparations 

Resin of Jalap; dose 2 to 5 grains. 

Compound Jalap Powder; dose 15 to 60 grains. 

This contains jalap and cream of tartar. 

JAMESTOWN WEED 

See Stramonium. 

JAVELLE SOLUTION 

See Chlorine. 

JAWS 

Treatment of New Growths of the Jaws.—If the cysts 
are small, they are removed and the membrane which lines 
the cavity is destroyed. If necessary, the cavity is packed 
and the wound permitted to heal by granulation tissue. The 
only treatment is to keep the mouth clean. 

In the case of benign tumors, the tooth about which the 
tumor grows is removed and with it a portion of the bone. 

The removal is accomplished by a Gigli saw. It is always 

convenient to have at hand an actual cautery or Horsley’s 

wax to control the hemorrhage which may ensue from the 

bone. 

The cases of malignant growths, either carcinoma or 
sarcoma, demand radical operation. In the case of the upper 
jaw, this is not so practical because, with the removal of 
the bone, the eyeball loses its support and drops from its 
normal anatomical position resulting in a condition of double 
vision or diplopia; and, by removing the hard palate, a com- 


JOINTS 


munication is made between the nose and mouth. However, 
in spite of these two obstacles, the operation is occasionally 
done. 

The removal of the lower jaw, however, is not so difficult; 
it may be removed either partially or in its entirety. The 
actual operative technic is more of interest to the surgeon 
than the nurse and will not be discussed here. The nursing 
procedures are the same as for any radical operation on 
either the upper or lower jaw. 

Ante-operative Treatment. —The mouth should be 
cleansed very carefully. The operative field, in the male, 
should be prepared by shaving an hour before the operation, 
as the beard sometimes grows very rapidly and nothing is 
more disagreeable than to have the patient ehter the operat¬ 
ing room not properly prepared. 

Post-operative Treatment. —The packing, which is intro¬ 
duced at operation into the area vacated by the maxilla, is 
removed, as a rule, after twenty-four hours. The space left 
by the removal of the upper jaw should be sprayed through 
the mouth every two to three hours with some antiseptic 
solution. The patient, as soon as he is able, should wash 
his mouth himself every two or three hours. For the first 
three days, it is better not to give food by mouth; the 
nourishment is supplied either by nutriment enemata, or by 
nasal gavage, the catheter being passed through the nostril 
on the sound side. As soon as the wound granulates, the 
patient may be given a liquid diet, the food always being 
introduced along the sound side of the mouth. Great care 
should be taken that the mouth be thoroughly cleansed after 
each feeding. Some surgeons request that the cavities be 

lightly packed with gauze during feedings so as to prevent 
the liquid food from entering the operative wound. This 
is not so important a procedure with liquids as it is with soft 

diet, which is allowed after about three weeks. It is 

unnecessary to confine the patient to bed any longer than 
four days, provided that everything goes smoothly, for 

needless confinement to bed often causes weakness. 

JOINTS, CLASSIFICATION OF 

Joints or Articulations are connections existing between 
bones. 

T. Sutures .—Articulations by processes 
and indentations interlocked together. 
A thin layer of fibrous tissue is 
interposed between the bones. 

2. Synchondrosis. — Temporary joint. 
Cartilage between bones ossifies in 
adult life. 


Immovable 

Joint 

or 

Synarthrosis 



JUNIPER 


1. Symphysis. —The bones are united 
by a plate or disc of fibro-cartilage 
of considerable thickness. 

J 2. Syndesmosis. —The bony surfaces are 
united by an interosseous ligament, 
as in the lower tibio-fibular articula¬ 
tion. 

'i. Arthrodia. —Gliding joint; articulates 
by plane surfaces which glide upon 
each other. 

2. Ginglymus. —Hinge or angular joint; 
moves backward and forward in one 
plane. 

3. Enarthrosis. —Ball-and-socket joint; 
articulates by a globular head in a 
cup-like cavity. 

i 4. Trochoides. —Pivot joint; articulates 
by a pivot process turning within a 
ring, or by a ring turning around a 
pivot. 

5. Condylarthrosis. — Condyloid joint; 
ovoid head received into elliptical 
cavity. 

6. Reciprocal Reception. —Saddle joint; 
articular surfaces are concavo-convex. 

V 

JUNIPER 

Juniper is obtained from the unripe, full-sized berries of 
the Juniper communis, or juniper plant. Its active principle 
is a volatile oil, the oil of juniper, which is obtained by 
distilling the berries. 

Local action: Juniper produces slight redness of the skin 
and mucous membranes if applied locally. 

Internal Action.—Taken internally: It increases the 
secretion of the stomach and intestines. It thereby increases 
the appetite and aids digestion. Its principal effect, how¬ 
ever, is to increase the flow of urine. 

Poisonous Effects 

Overdoses of juniper usually cause painful urination with 
bloody urine. 


Slightly 

Movable 

Joint 

or 

Amphiarthrosis 


Movable 

Joint 

or 

Diarthrosis 


Administration 

Juniper is rarely given alone. It is usually combined with 
cream of tartar or other alkaline diuretics. 




JUNIPER 


Preparations 

Oil of Juniper; dose 5 to 15 minims. 

Spirits of Juniper; dose 30 to 60 minims. 

The most commonly used preparation, however, is the 
infusion of juniper berries. It is made by boiling an ounce 
of the berries in a pint of water, and is given in doses of 
30 to 60 minims. 


K 


KAMALA 

Kamala is a reddish brown powder consisting of the 
minute glands and hairs from the capsules of Mallotus 
philippensis, an East Indian shrub. Its active principles are 
two resinoid substances, kamalin and rottlerin. 

Kamala destroys the tape worms and causes profuse 
diarrhea so that no cathartic is necessary after its use. 

About i to 2 drams of the powder is given in syrup, 
and repeated in two hours if the bowels do not move. A 
tincture of kamala is also occasionally given. 

See Anthelmintics. 


KELENE 

See Anesthetics (Ethyl Chloride). 

KIDNEYS 

The kidneys are two compound tubular glands, placed at 
the back of the abdominal cavity, one on each side of the 
spinal column and behind the peritoneal cavity. They cor¬ 
respond in position to the space included between the upper 
border of the twelfth thoracic and the third lumbar vertebra. 
The right is a little lower than the left in consequence of 
the large space occupied by the liver. 

Capsule and supports. —The kidneys are covered by a thin 
but rather tough envelope of fibrous tissue called the capsule. 
The kidneys are usually embedded in a mass of fatty tissue 
termed the perirenal fat, and are not held in place by any 
distinct ligaments, but rather by the pressure and counter¬ 
pressure exerted upon them by neighboring structures. 

Size and shape. —Each kidney is about four and one-half 
inches long, two and one-half inches broad, one and one-half 
inches thick, and weighs about four and one-half ounces. 
They are bean shaped, with the concave side turned toward 
the spine, and the convex side directed outward. Near the 
center of the concave side is a depression called the hilum, 


KIDNEYS, SURGICAL CONDITIONS OF 


which serves as a passageway for the ureter, and for the 
blood-vessels, lymph-vessels, and nerves going to and from 
the kidney. 


KIDNEYS, DISEASES OF 

See Nephritis. 

KIDNEYS, SURGICAL CONDITIONS OF 
Treatment of Acute Infections of the Kidneys. —In 

pyelitis, the treatment is primarily medical. The patient 
is placed in bed; fluids are forced to about 2000 c.c. a day, 
and urotropin 10 grains, or more is given by mouth three 
times a day. If it is thought that the pyelitis is in some way 
due to a chronic constipation with a dilated caput coli, colon 
irrigations are especially indicated. Occasionally the pelvis 
of the kidney is irrigated directly through a ureteral catheter 
which has been introduced into the ureter by means of a 
cystoscope. This is an instrument designed to give a view 
of the interior of the bladder. It has the general shape 
of a sound, has a telescopic lens and carries an electric 
light to illuminate the interior of the bladder which has 
been previously distended with warm boric acid. It has 
several modifications and attachments so that small catheters 
may be passed into the ureteral orifices. By this means the 
urine from both kidneys may be collected separately, and the 
condition and functional activity of each kidney may be 
judged. 

In pyonephrosis, the kidney is incised in the region of the 
pelvis and the pus removed. This operation is spoken of as a 
nephrotomy. But if the kidney shows many areas of infec¬ 
tion, the so-called acute surgical kidney, it may be completely 
removed (nephrectomy). 

Post-operative Treatment of Nephrotomy. —Inasmuch as 
urine as well as pus will escape from the kidney through the 
wound, the dressings should be frequently removed and 
changed to prevent maceration of the skin. The patient is 
placed upon forced fluids, their amount carefully measured, 
and the urinary output approximately estimated. These cases 
are rather protracted, lasting from six to eight weeks. The 
nutrition should be particularly watched and every effort 
taken to maintain or increase the patient’s weight by a 
liberal diet, high in carbohydrates. When the patient is al¬ 
lowed up, there is often a leakage of urine through the 
wound, and to prevent the embarrassment of a constant 
urinous odor, a lumbar urinal may be worn. 

Nephrectomy. —When it is evident that the kidney has 
been destroyed to such a degree that it is of little use to the 
organism, it is much better to remove it completely. A 


KIDNEYS, SURGICAL CONDITIONS OF 

nephrectomy is always done for the acute septic kidney, 
diffuse pyonephrosis, tuberculosis, or new growths, provided 
the physical condition of the patient will permit such an 
operation, and the other kidney is present and not markedly 
diseased. If the ureter is definitely pathological, it is dis¬ 
sected down until a healthy portion is found, or if the 
entire length is affected, it might be totally excised together 
with the kidney. 

Post-operative Treatment. —The treatment is similar to 
that of a nephrotomy. The drainage tubes are removed at 
the end of three or four days, and the patient is kept in bed 
for three to four weeks, until the wound has firmly and 
completely healed. 

Renal Calculus. —Renal calculi or kidney stones may be 
found in the substance of the kidney, in the pelvis, or in 
the ureter. The stones may be single or multiple, rough 
or smooth, and may be present in one or both kidneys. 
The symptoms which they cause are those of renal colic. 
This is a severe colicky pain in the loin radiating downward 
to the testicle or vulva. Blood is found in the urine 
(hematuria) and there is occasionally frequency and urgency 
with burning micturition. 

Treatment of Renal Calculus. —Patients who have a ten¬ 
dency to renal colic, as evidenced by a previous history of 
attacks, or the passage of small calculi, and whose urine 
contains an excess of urates, should be placed upon a diet 
which is poor in protein. Alcohol is absolutely prohibited, 
also tea and coffee. Alkaline drinks should be administered, 
and the alkaline diuretics, such as acetate, bi-carbonate, and 
citrate of potassium should be given freely and often. 

Operative Treatment. —When there is definite evidence of 
a stone from the clinical history augmented by positive radio- 
graphic and cystoscopic findings, operation is indicated, for 
it is the only measure which will insure permanent relief. 
The operations performed for kidney stones are two in 
number: nephrolithotomy and nephrectomy. 

Nephrolithotomy. —In this operation the procedure is simi¬ 
lar to a nephrotomy. The usual lumbar incision is made 
with the patient in the kidney position, the kidney ex¬ 
posed, and the pedicle, that is the renal artery and the 
renal vein, are grasped by the hand of an assistant while the 
surgeon incises the kidney along the convex border. Under 
these hemostatic conditions the bleeding is very little. The 
calices of the pelvis and kidney tissue are carefully examined 
and the stone removed. The kidney is sutured together with 
mattress sutures of chromic catgut on a blunt, non-cutting 
needle. 


KORSAKOW’S PSYCHOSIS 

Post-operative Treatment. —The routine procedure in all 
surgical kidney cases demands that fluids be forced to the 
maximum. All the urine excreted should be accurately 
measured and saved for the inspection of the attending 
surgeon. The elimination must be especially watched, be¬ 
cause after this operation, urinary suppression is apt to 
result. For a day or so the urine is apt to be bloody; this 
is not particularly alarming. During this period patients 
often complain of symptoms simulating renal colic, due to 
clotted blood passing down through the ureter. The pain 
is easily controlled by small doses of morphine by hypodermic 
injections. 

KINO 

Kino is the dried juice of the Pterocarpus marsupium, an 
East Indian tree. It is a strong astringent, contracting 
tissues and checking the secretions of the mucous membranes, 
because of the tannic acid which it contains. 

Preparation 

Tincture of Kino; dose V2 to 2 drams. 

KNOCK-OUT-DROPS 

See Chloral Hydrate. 

KOCH’S POSTULATES 

According to Koch an organism can be considered the 
causal agent of a given disease only after it has fulfilled 
certain requirements: (1) it must always be associated with 
the disease; (2) be isolated in pure culture; (3) produce 
the disease when inoculated into a healthy animal, and (4) 
be obtained again in pure culture. For a long time these 
conditions were accepted as the only proof of such a causal 
relationship. Recent studies in immunology and the demon¬ 
stration of specific serum reactions have, however, rendered 
such a procedure for'the most part unnecessary. 

KOLA 

See Caffeine. 

KORSAKOW’S PSYCHOSIS 

This is a form of alcoholic psychosis and is usually accom¬ 
panied by characteristic physical symptoms due to the pres¬ 
ence of a polyneuritis. 

Physical symptoms. —At first there may be neuralgic 
pains and tingling sensations in the hands and feet, and 
then muscular weakness and tenderness over the muscles 
and deep nerve trunks of the limbs. Later, there may be 
both ankle and wrist drop due to the paralysis of the ex¬ 
tensor muscles. 


KOUSSO 


Mental symptoms. —Perception is disordered during the 
acute stage for the patient misidentifies persons, is dis¬ 
oriented as to time and place and may have hallucinations. 
There is a marked defect of retention, and the events of the 
preceding moments are not remembered. To fill in and 
cover up the lapses in memory the patient will fabricate in a 
most extraordinary manner. The emotions are disturbed, 
and the patient may be very suggestible, responding quickly 
to whatever is said or proposed. 

Nursing procedures. —During the acute stage the patient 
must be cared for in bed. Pillows and pads should be ar¬ 
ranged so as to give greatest comfort. The feet and hands 
should be supported by small pillows if necessary. Pressure 
over the areas of hyperesthesia should be avoided and the 
bedclothes supported by means of cradles. As the acute 
symptoms subside, massage, muscle training and electric 
treatments are prescribed by the physician. Improvement 
takes place very slowly and care must be taken to avoid 
fatigue. To improve the memory defect, simple rhymes and 
easy exercises in memorizing numbers are given in the be¬ 
ginning, but as these are mastered the exercises may be 
made more exacting in their demand on attention and 
memory. Convalescence may be months in duration. 

Occupations. —Very little can be attempted in the be¬ 
ginning, but when the acute stage is over passive motion 
of the fingers and toes may be given, and the patient inter¬ 
ested in training his own muscles, especially those of the 
hands. As fast as control is regained, simple tasks like 
pushing marbles and blocks about, grasping and moving 
crayons to color outlined pictures may be given. Other 
forms of light handicraft may be given as fast as improve¬ 
ment takes place. The exercise must be passive until such 
time as the physician permits the patient to use his limbs. 
Walking for a short distance or for a short period with sup¬ 
port on both sides may be attempted, care being taken to 
avoid fatigue. These periods may be lengthened as the con¬ 
dition improves and simple forms of gymnastics may be tried. 

KOUSSO 

See Cusso. 

KRAMERIA (RHATANY) 

Krameria is obtained from the roots of Krameria triandra, 
and of Krameria ixima, Para rhatany, and Peruvian 
rhatany, two South American shrubs. 

They are powerful astringents, contracting the tissues and 
checking the secretions, because of the tannic acid which they 
contain. 


KUMYSS 


Preparations 

Extract of Krameria; dose 5 to 15 grains. 
Fluidextract of Krameria; dose 10 to 60 minims. 
Tincture of Krameria; dose y<i to 2 drams. 
Syrup of Krameria; dose Vt to 2^ drams. 

KRESAMINE 

See Cresols. 


KUMYSS 

Kumyss or koumiss, is a fermented liquid prepared 
from mare’s milk by the Tartars, who originated it. It is 
made from cow’s milk in this country by fermenting milk 
with yeast. Liquid yeast is added to the milk, and the re¬ 
sulting fluid is then allowed to stand for about eight to ten 
hours in a lukewarm place. 


LABARRAQUE ’ S SOLUTION 

See Chlorine. 

LABOR, MANAGEMENT OF NORMAL 

Surgical Cleanliness.— The great principle that should 
overrule and guide every move at a case of labor is that 
of strict surgical cleanliness. Asepsis should be aimed at in 
everything, and so far as instruments are concerned should 
be secured. In everything the strictest antisepsis should be 
carried out. These are the principles on which labors are 
conducted in hospitals, and in them puerperal sepsis is 
almost unknown. But it is a melancholy fact that in 
private practice the deaths from puerperal sepsis far out¬ 
number those from all the other complications of childbirth 
put together. Moreover, apart from actual mortality, sepsis 
is the greatest risk a woman has to run in childbirth from 
the point of view of her subsequent health and well-being. 
The next all-important point to bear in mind is that in all 
cases the infection is conveyed to the patient from with¬ 
out; and in nine cases out of ten is to be traced to some 
breach in the asepsis or antisepsis of the physician or nurse. 

Antiseptic Methods. —There are three main lines by which 
we may endeavor to reduce the risks of interference, namely: 
(i) strict personal asepsis; (2) careful cleansing of the ex¬ 
ternal genitals of the patient; (3) infrequency of vaginal 
examinations. 

Strict Personal Asepsis .-—This applies alike to nurse and 
physician. It includes a great deal more than the mere 
washing of hands. The physician in general practice cannot 
avoid coming into contact with infectious cases, or cases of 
septic wounds, ulcers, etc. Recent contact with such a case 
necessitates a complete bath and change of clothes before 
attendance on a labor. A further defence for the patient is 
the wearing of a sterile overall or gown. 

The cleansing of the hands before a vaginal examination 
should be as carefully and scrupulously carried out as for a 
major operation: 




LABOR, NORMAL 


(1) 5 to io minutes scrubbing with hot water, soap, and 
lysol, and a nail-brush that has been boiled or soaked for 
some time in antiseptics. Particular attention must be paid 
to the nails and nail-folds. 

(2) Thereafter three minutes soaking in an antiseptic solu¬ 
tion, such as biniodide of mercury in spirit 1:1000, or a 
similar strength of corrosive sublimate aqueous solution. 

Where the hands have recently been in contact with septic 
matter the best plan is to wash them as in (1), then soak 
them in a saturated solution of potassium permanganate till 
they are mahogany colored. Wash this off in a warm solu¬ 
tion of oxalic acid, and then soak them as in (2). 

The routine use of rubber gloves that have been boiled and 
kept sterile adds much to the safety of the patient. If, 
however, gloves render one less careful in the cleansing of 
the hands, they are worse than none. For a glove may very 
easily be torn, or burst, and then the perfunctorily cleansed 
fingers come into contact with the genital tract. 

Cleansing the Vulva .'—Wherever possible the patient should 
have a complete bath at the very commencement of labor. 
The nurse should then pay special attention to the genitals. 
The hair, if very abundant or long, should be cut or shaved. 
Before an examination is made the vulva must be well washed 
with soap and water and lysol. The labia minora must be 
separated and wiped with pledgets of wool soaked in 1:1000 
biniodide, or 1 per cent, lysol. The pledgets must always be 
drawn from before backward to prevent carrying forward 
any septic matter from near the anus. No pledget must be 
used for more than one wipe. Previous to this the nurse 
should have seen to it that the rectum and bladder are 
emptied. It is well for her to give an enema in every case, 
irrespective of whether the bowels have acted naturally or 
not. 

Infrequent Vaginal Examinations .—The use of abdominal 
palpation instead of this method of examination in normal 
cases is strongly recommended. Where a vaginal exam¬ 
ination is necessary it must be done with scrupulous care. 
The patient should be on her back rather than on her side, 
so as to diminish the risk of the hand coming into contact 
with the anus. The hands and the vulva having been 
cleansed as described, the labia minora are held apart by the 
fingers of the left hand, and the fingers of the right hand 
introduced without coming into contact with the vulva at 
all, or at least only with the inner surfaces of the labia 
minora which have been cleansed in the way described. 
Try to ascertain— 

(1) Presentation and position. 

(2) Is the head engaged and fixed between pains? 


LABOR, NORMAL 

(3) Is the head flexed, and how far has it passed into 
the pelvis? 

(4) Rate and character of fetal heart-sounds. 

(5) State of fullness of the bladder. 

(6) Duration and frequency of the pains. Are they true 
or false? 

This ought in most cases to suffice. But if necessary the 
vaginal examination may then be made, the hands and the 
patient being suitably prepared. It is well to introduce 
the fingers during a pain and prolong the examination until 
it has passed off, so that one can learn the state of matters 
both during and between pains. Points to be ascertained 
or confirmed are— 

(1) Is she in labor? 

(2) State of os uteri—how far advanced in labor? 

(3) Presentation and position. 

(4) Are the membranes ruptured? If not, be careful not 
to rupture them. 

(5) State of os, vagina, and perineum as to -distensibility 
or rigidity, moistness, or dryness, etc. 

(6) Is pelvis normal? (if not previously ascertained, as it 
should have been). 

(7) Is cord prolapsed? 

Diagnosis of Labor. —There are three signs: (1) The 
pains are true pains, i.e., they are accompanied by hardening 
of the uterus felt by abdominal palpation, and by opening of 
the os and bulging of the membranes felt per vaginanj. (2) 
The “show.” (3) In multiparae the head is fixed between 
pains. In primiparae engagement of the head occurs before 
labor. 

False Pains. —These are painful, colicky contractions of the 
intestines, or bladder, or abdominal walls, or sometimes 
partial contractions of the uterus. They tend to come on 
before term, sometimes several days or even a week or a 
month before. They may be excited by some digestive upset, 
or by some purgative medicine that has failed to act prop¬ 
erly, or by constipation. They are often extremely painful, 
but are characterized by irregularity of onset, by being 
situated more in front than in the back, and by the absence 
of any accompanying contraction of the uterus. They should 
be treated according to the cause—attention to the digestion, 
enemata, emptying a distended bladder, and if necessary, 
sedatives. 

Having completed the examination, again reassure the 
patient if all is well. If there is anything wrong, do not 
alarm the patient but tell the relatives. Under no circum¬ 
stances commit yourself definitely as to the time when the 
labor will be over. Prognosis of this kind is impossible. 


LABOR, NORMAL 


The nurse should give the patient an enema whether the 
bowels have acted or not, unless this has already been done. 
The bed, the room, and the patient’s clothes also need atten¬ 
tion. 

The Bed. —This should be arranged as follows: 

(1) A narrow, single bed is best, and should be accessible 
on both sides. 

(2) The mattress should be firm. Soft spring mattresses 
may be stiffened by placing a broad board beneath them. 

(3) Mackintosh sheeting. 

(4) Binding blanket. 

(5) Two clean sheets. (These all to be tucked in under 
the mattress). 

(6) Mackintosh sheeting hanging over the edge on the 
right-hand side. 

(7) Pad of absorbent wool. 

(8) The upper bedclothes according to the temperature of 
the room. The sheet should always be folded over and 
safety-pinned to the counterpane, so that all the clothes may 
be raised easily and quickly. 

The carpet at the side of the bed should be removed or 
protected by waxcloth or stout paper and a tin bath or 
large basin placed so as to catch any blood or liquor amnii 
that may escape over the side of the bed. 

If the patient is unable to afford mackintoshes, etc., sev¬ 
eral clean newspapers or sheets of glazed brown paper may 
be used. 

The Room must be kept well ventilated, but not cold. 

Patient’s Clothing. —This should be light, but sufficiently 
warm. When she lies down at the close of the first stage, 
her hair should be plaited, a pair of clean stockings put on, 
and two nightdresses. Both should be clean, but one old. 
The old one is put round the lower part of the body. The 
other is put on in the ordinary way, and then tucked up 
under the arms, so that it can be brought down after labor 
is over, and all the soiled clothing, etc., removed. 

When the second stage begins the patient should retire to 
bed. She should now be encouraged to bear down. To this 
end it is helpful to place a stool on the bed at the foot, 
so that during a pain she can put her feet on it and so get 
her lower limbs fixed. A roller towel should also be tied 
to the foot of the bed. To this she clings during a pain, and, 
holding her breath, bears down more effectively. Between 
pains she should straighten her legs again to avoid cramp. 
This cramp is easily excited by the musclar effort, plus the 
pressure of the head on the sacral nerves. Treat it by rub¬ 
bing with hot cloths. The pain may be mitigated by the 
nurse pressing on the sacrum with her knee or fist. 


LABOR, NORMAL 

When the membranes rupture it is frequently desirable to 
make a vaginal examination to see that everything is right, 
and that the cord has not prolapsed. This must be done with 
all due antiseptic precautions. In most labors this is the only 
vaginal examination necessary, and even it may often be 
done without and the progress gaged by pelvic palpation from 
the abdomen. 

If the os is fully dilated, and the membranes still intact, 
it will hasten delivery to rupture the membranes artificially. 
This can sometimes be done by nipping them between the 
fingers, but it is easier to use a sterilized instrument such 
as the stillette of a catheter, or a hairpin straightened out 
and sterilized by heating it to red heat in the fire, and 
washing it in antiseptics. 

Sometimes the anterior lip of the cervix becomes enor¬ 
mously thinned out over the head, while the partially opened 
os is situated high up behind the head. In such a case 
try to pull down the os and stretch it gently with the fingers. 

Anesthesia in Labor.—General anesthetics are very largely 
used to produce a degree of analgesia, merging into more 
or less complete anesthesia during the latter part of the 
second stage. Complete “surgical” anesthesia is not neces¬ 
sary or desirable in labor unless operative interference is 
required. A light anesthesia, known as “anesthesia to an 
obstetrical degree,” is sufficient in normal labor. 

Chloroform .—Chloroform is most commonly used; but 
ether is also largely employed; and not a few obstetricians 
employ a mixture of both. 

Chloroform should be given by the open method, and a 
flannel-covered mask is much the most economical means of 
administration. A beginning is made when the pains are 
such as to cause serious suffering, usually towards the very 
end of the first or beginning of the second stage. To begin 
with, a whiff should be given only during a pain, and the 
mask removed when the pain passes off. As the pains come 
in closer succession, the administration becomes gradually 
less intermittent, until by the time the head is being born 
the administration is practically continuous and the patient’s 
condition is for a few minutes one of complete anesthesia. 
As soon as the child is born the mask is finally removed. 

The administration of chloroform to this light degree of 
anesthesia by the intermittent method described is, speaking 
generally, a safe procedure during labor. Provided a suffi¬ 
ciently light degree of anesthesia is maintained, the effi¬ 
ciency of the uterine contractions is not impaired, and there 
is no tendency to inertia or to post-partum hemorrhage. 
Unduly prolonged or deep anesthesia, on the other hand, may 
lead to these dangers. 


LABOR, NORMAL 


It must not be assumed that the use of chloroform is 
devoid of risk. It only approaches that happy condition when 
it is administered with all due precautions and as described 
above. Further, there are certain maternal conditions which 
make the use of chloroform particularly risky. These are 
toxemic states, especially hyperemesis gravidarum, acute 
yellow atrophy of the liver, and eclampsia. In all of these 
the liver cells are already diseased, and the deep or pro¬ 
longed administration of chloroform may lead to further 
damage, and even to death following “delayed chloroform 
poisoning.” 

A mixture of chloroform and ether may be employed ex¬ 
actly as pure chloroform is used. It is believed by some 
that the stimulant effect of the ether diminishes the risk 
attached to the chloroform. 

Ether alone may be used, except where there are pul¬ 

monary complications such as bronchitis. It may be given 
by the open method by using the face-piece and dome of a 
Clover’s inhaler without the bag. 

Care of the Perineum.—A tear of the perineum is the 
commonest accident in the labor of a primiparous woman. 

Although not in itself dangerous, it may be a source of 
septic mischief in the puerperium, and later may cause much 
trouble and ill-health by favoring displacements of the 

uterus. Every effort should be made to avoid the ac¬ 
cident. 

The causes of perineal tears are three: 

(1) Relative disproportion between the head and the 
outlet. 

(2) Too rapid expulsion without the perineum having 

time to stretch. 

(3) Faulty mechanism, whereby a larger circumference of 
the head than necessary passes through the outlet. 

The means of combating these causes are as follows: 

(1) In all cases give the head plenty of time to stretch 
the perineum. 

(2) When the pains are strong and the head tends to 
advance too rapidly, give more chloroform to diminish the 
strength of the pains; try to prevent the patient from bearing 
down; retard the head by pressing it back with the hand. 
Never press on the perineum itself. 

(3) Try to favor the maintenance of flexion. Press the 
sinciput upwards and forwards, and so force the occiput well 
under the subpubic arch. In this way the diameters brought 
over the perineum are the suboccipito-bregmatic and the sub- 
occipito-frontal, and these are the smallest available diam¬ 
eters. 

(4) Try to deliver between pains. By doing so we have 


LABOR, NORMAL 

the advantage of dealing with a perineum whose muscles 
are relaxed instead of tightly contracted. 

When the head is born, support it in the right hand. 
Stop the chloroform. Do not unduly hasten the birth of 
the body unless the child’s face becomes very cyanosed, and 
it makes convulsive movements. Feel round the neck for the 
umbilical cord, and if it does happen to be round the neck, 
draw a loop of it down and slip it over the head. Wipe the 
eyes with a pledget of wool soaked in boracic lotion. It is 
a good plan to wipe out the mouth in the same way. 

If the uterus does not within a moment or two proceed to 
expel the shoulders, place the left hand on the fundus and 
rub it so as to stimulate a contraction. If necessary aid the 
expression by pressure, and in every case follow with the 
hand the descent of the fundus. 

If the shoulders appear to stick, pass the right forefinger 
in and hook it into the anterior axilla, and pull down the 
shoulder. Do not pull on the head or neck to expedite 
delivery. 

As soon as it is born the child should cry. If it does not 
do so, clear its mouth of mucus by means of a small swab, 
hold it up by its legs and gently slap it on the back. If 
necessary suck the mucus out of its trachea by means of a 
catheter. A little friction and sprinkling with a few drops 
of cold water usually stimulate it to inspiration. 

Ligature of the Cord. —As soon as respiration is well estab¬ 
lished, lay the child on the bed on its back. Wait for a few 
minutes until the cord shows signs of ceasing to pulsate. 
Then take the cord at a spot about two inches from the 
umbilicus, squeeze away the Wharton’s jelly so as to make 
it a thin cord, and apply a ligature, and tie tightly with a 
surgical or reef knot. Apply a second ligature about three 
inches from the vulva. The second ligature is not neces¬ 
sary unless there is a second child in the uterus, when it 
may save its life if the circulations of the two children 
communicate. In any case, however, it is a cleanly habit, 
and should always be done. Cut the cord between the liga¬ 
tures half an inch from the umbilical ligature. Take care 
to hold the cord up on the fingers when cutting, otherwise 
you may easily injure the infant. The child should then 
be wrapped in a warm flannel, and laid aside in a safe 
warm place until the nurse is ready to bathe it. Take a 
second look at the cord to see that it is not bleeding. If 
it is, put on a second ligature. 

The moment the child is born the third stage is begun. 
The great rule for the conduct of this stage is to keep con¬ 
trol of the fundus of the uterus by the hand on the abdomen 
during the whole stage, and for some time after it. This is 


LABOR, NORMAL 


done so that one may feel at once if the uterus becomes very 
flabby or enlarged, which means bleeding inside it. Remem¬ 
ber that the uterus must become somewhat soft in the in¬ 
tervals between contractions, but there should always be 
sufficient permanent retraction to prevent it from feeling 
actually flabby. Do not rub or knead the fundus unless you 
think it is becoming too soft, but if you do think so then 
grasp and knead it to stimulate it to contract again. Un¬ 
necessary and over-zealous rubbing up of the fundus is apt to 
lead to retention of the placenta by an irregularly con¬ 
tracted uterus, and that may mean serious and dangerous 
hemorrhage. 

The correct way to keep control of the uterus is to sink 
the ulnar edge of the hand into the abdomen above and be¬ 
hind the uterus, and just keep it there in light contact with 
the uterus. As long as the outline of the uterus can be felt 
there is not likely to be any risk of serious hemorrhage. 

The placenta usually comes away within twenty minutes. 
The placenta sometimes remains in the vagina, whose mus¬ 
cular walls are too weak to expel it. When this occurs it 
should be removed from the vagina. 

If the placenta is in the vagina, knead the uterus to a 
contraction; and then grasp the uterus and press it gently 
and steadily downwards and backwards in the axis of the 
pelvic inlet. It will push the placenta out before it without 
the necessity of using any force. 

As the placenta rolls out through the vulva it should be 
grasped by the hand to prevent its weight tearing the 
membranes. It should then be turned round several times so 
that the membranes are twisted into a sort of rope. This is 
generally sufficient to draw them gently out without tearing. 

Retained Placenta. —Where the placenta is still in the 
uterus after the lapse of forty minutes it may be expelled by 
Crede’s method. The uterus is grasped through the ab¬ 
dominal wall by placing the fingers behind it and the thumb 
over the anterior wall. When it contracts it should be 

squeezed from before backwards, and at the same time 
pressed downwards and backwards in the axis of the inlet. 
This maneuver should not be repeated more than once or 

twice, and never attempted unless during a contraction. Care 
should also be taken to grasp the uterus from back to front, 
not from side to side, as otherwise the ovaries may be 

squeezed and severe shock produced. 

Pulling on the cord should never be employed under any 
circumstances. 

Examination of the Placenta. —The placenta should be 

received in a clean basin, and later floated out in water to 
see that it and the membranes are quite complete. Hold the 


LABOR, NORMAL 

placenta in both hands, maternal side up. The various lobes 
should fit each other accurately, or if any tear has occurred 
the edges come together with a little gentle pressure. If 
a piece of the placenta has actually been left behind, the gap 
will remain obvious even after trying to press the edges 
together. Then place it in the basin and hold up the mem¬ 
branes. They should look large enough to have contained 
the fetus and liquor arnnii. Look for any tears in the 
amnion, and if there is such, note if any vessels pass from 
the edge of the placenta to the tear. Such a condition indi¬ 
cates a secondary or succenturiate placenta. 

Retained Membranes. —If much is left in the uterus it may 
cause bleeding. Therefore look out for any symptoms of 
this, and give a good dose of ergot. The membranes will 
probably come away with the lochia. Very rarely it may be 
wiser to explore the uterus with the fingers and remove 
them, but remember the risk of sepsis in such an operation. 

Ergot.—After the placenta is born, but never until then, 
ergot may be given to favor uterine contraction and retrac¬ 
tion. It is desirable to do so when the uterus is not con¬ 
tracting well, but in a normal case it is not necessary. It 
may be given by the mouth (half dram of the fluid extract), 
but preferably by a hypodermic needle passed directly and 
deeply into the gluteal muscles. There are several good 
preparations sold in glass capsules of sterilized and stand¬ 
ardized solutions ready for injection. 

Cleaning Up the Patient. —The vulva and surrounding 
parts must now be cleaned up. This must be done with 
care. Pledgets of sterile wool soaked in weak lysol solu¬ 
tion per cent.) are used. All wiping is done from before 
backwards, and no pledget used for a second wipe. 

The absorbent pad upon which the patient has been lying 
is removed before the final washing, and the buttocks and 
thighs dried. The draw sheet and upper mackintosh sheet 
are then withdrawn, a vulvar pad placed on the vulva, and 
the binder slipped under the patient, who is again turned on 
her back. The vulvar pads are best made of Gamgee tissue, 
about ten inches long and four wide, sterilized, or scorched 
brown at the fire. Before fastening the binder feel the 
uterus to make sure that it is firm. 

Binder. —A binder is not necessary, but it is a great com¬ 
fort to the patient, and gives a grateful and comforting 
support to the pelvic joints and muscles, which are strained 
and weary. The lower edge of the binder must come about 
two inches below the trochanters. Fasten the lower part 
first and make it fairly tight. The part over the abdomen 
should never be so tight that you cannot slip your closed 
hand under it perfectly easilv. The lower edge keeps the 



LACTATION, DIET IN 

vulvar pad in position. Fix the binder with stout pins or 
safety pins. 

Pulse. —Before finishing with the mother count the pulse. 
It is usually slow—below 80. If it is above ioo make sure 
that there is no sign of hemorrhage from or into the uterus. 
Anesthetics, especially scopolamine, may cause a slight quick¬ 
ening of the pulse, that is not of any bad significance. 

Temperature. —This also should be taken at the close of 
labor. It should be below 99°. Frequently it is subnormal 
from the loss of body heat. 

The Baby has meanwhile been lying wrapped in a flannel 
in some warm corner. The bath is now prepared with a little 
water at a temperature of about ioo° F. Two or three inches 
of water is ample. First gently smear the child with olive 
oil. This softens the vernix caseosa, or white cheesy stuff 
covering it. Then gently wash it all over with soap, begin¬ 
ning at the face and head. The child should never be im¬ 
mersed; and its face should never come in contact with 
water that has been used for the body. After drying it, 
examine it for congenital defects such as imperforate anus, 
cleft palate, etc. It is very important to guard against a 
possible ophthalmia, by dropping two drops of i per cent, 
solution of silver nitrate into each eye. This makes the 
eyes red for a day or two, but may be the means of saving 
the child’s sight. 

Pay particular attention to the cord. Dry it very carefully, 
see that it is not bleeding. Powder it with some boracic and 
starch powder, and wrap it in a small dressing of dry sterile 
gauze. Lay this flat on the abdomen, and put on the binder, 
not too tight. This should be sewn, not pinned, together. 
The flexures of the groins and the cleft of the nates may be 
dusted with starch and boracic. 

LACERATION 

See Wounds. 

LACTATION, DIET IN 

Diet of Mother. —Her dietary need not differ materially 
from that to which she is accustomed. She must avoid indi¬ 
gestible foods or any article which has been proved to disa¬ 
gree with either the inffant or herself. 

Factors Regarding Secretion of Milk. —Constipation, 
worry, nervous excitement, and over-fatigue all have an 
unfavorable effect upon the secretion of milk and must 
therefore be avoided by the nursing mother. 

The Bowels. —Constipation of the mother reacts quickly 
and unfavorably upon the health and comfort of the baby, 
hence it should be avoided by eating coarse breads, green 


LACTIC ACID 


vegetables, and fruits, when they do not disagree with the 
baby, by drinking plenty of water and taking a certain 
amount of outdoor exercise to keep her own health in good 
condition. 

Stimulating the Milk Production. —When the milk supply 
is deficient it will be advisable for the mother to drink a 
glass of milk or a bowl of cereal milk gruel between meals. 
Alcoholic beverages are not necessary to insure an adequate 
secretion of milk. The milk or milk gruels answer the 
purpose more efficiently and without bad results. 

Energy Requirements of Infant. —The average baby re¬ 
quires fifty calories per day per pound of body weight to 
cover his energy growth and development needs for the 
first three months of life, after which the rate of growth is 
less and his requirements decrease from forty-three to 
forty, then to thirty-five calories per day per pound by 
the end of his first year. 

Amount of Milk Needed for Infant.—Approximately two 

and one-third ounces to each pound of body weight per 
day covers the needs of the average baby. 

Fuel Value of Mother’s Milk. —Each ounce of milk yields 
twenty calories. 

The Making of Miur. —It has been estimated that for every 
calorie yielded by milk, two extra calories must be provided 
by food. 


LACTIC ACID 

Lactic acid is a thick, syrupy liquid formed in milk when 
it turns sour as a result of bacterial fermentation. It is 
also formed by the fermentation of milk sugar or grape sugar. 

When taken internally, it acts like the other organic 
acids (see Acetic Acid, Citric Acid, Oxalic Acid) : 

1. It increases the appetite and aids digestion. 

2. It is said to increase nutrition. 

3. It enters the blood as lactates and is excreted by the 
urine as alkaline carbonates. 

It is principally used, however, as a local application to 
heal tuberculous ulcers of the pharynx or larynx, and to 
remove diphtheritic membranes. The applications are very 
painful. 

Lactic acid is formed by the fermentation of bacteria in 
milk and is therefore contained in many fermented milks, 
such as Kumyss, Zoolak, Fermilac, etc. 

Preparation 

Lactic Acid; dose 5 to 30 minims. 

This contains 75 per cent, of pure lactic acid. 


LARYNX, SURGICAL CONDITIONS OF 


LAMELLAE 

Lamellae are small gelatin discs containing medicinal sub¬ 
stances, which are inserted between the lower eyelid and 
the eyeball. 

LAMINECTOMY 

See Spinal Cord, Surgery of. 

LAPACTIC PILLS 

See Aloes. 

LARYNGECTOMY 

See Larynx, Surgical Conditions of. 

LARYNX 

The larynx, or organ of voice, is placed in the upper 
and front part of the neck, between the base of the tongue 
and the top of the trachea. Above and behind lies the 
pharynx, which opens into the esophagus, or gullet, and on 
either side of it lie the great vessels of the neck. The 
larynx is broad above and shaped somewhat like a triangulai 
box, with flat sides and prominent ridge in front. Below 
it is narrow and rounded where it blends with the trachea. 
It is made up of nine pieces of fibro-cartilage, united by 
elastic ligaments, and moved by numerous muscles. 

The glottis. —Across the middle of the larynx is a trans¬ 
verse partition, formed by two folds of the lining mucous 
membrane, stretching from side to side, but not quite meeting 
in the middle line. They thus leave in the middle line a 
chink, or slit, running from front to back, called the glottis, 
which is the narrowest segment of the air passages. The 
glottis is protected by the leaf-shaped lid of fibro-cartilage, 
called the epiglottis, which shuts down upon the opening 
during the passage of food or other matter into the esoph¬ 
agus. 

The vocal cords. —Embedded in the mucous membrane at 
the edges of the slit are fibrous and elastic ligaments, which 
strengthen the edges of the glottis and give them elasticity. 
These ligamentous bands, covered with mucous membrane, 
are firmly attached at either end to the cartilages of the 
larynx, and are called the true vocal cords, because they 
function in the production of the voice. Above the true 
vocal cords are two false vocal cords, so called because they 
do not function in the production of the voice. 

LARYNX, SURGICAL CONDITIONS OF 

Foreign Bodies. —The most common way for foreign 
bodies to lodge either in the larynx, or further down in the 


LARYNX, SURGICAL CONDITIONS OF 


trachea, is for the individual to swallow them. The symp¬ 
toms which are produced will vary according to the size 
of the body and its location in the respiratory tract. Some¬ 
times they are expelled by coughing; at other limes they 
may remain. Cases are not rare in which the material has 
been of sufficient bulk to occlude the larynx, with death im¬ 
mediately ensuing from asphyxiation. 

Treatment. —Slapping the patient on the back, or inverting 
him may dislodge the foreign body. Or, if the patient is 
not so fortunate, it may be removed with forceps under 
direct vision, or either a Killian or Jackson laryngoscope 
may be necessary. These are instruments designed to 
enter the larynx. The pharynx and larynx may be cocainized, 
or the patient may be placed under deep anesthesia. The 
laryngoscope is passed through the mouth and pharynx into 
the larynx, the head and neck being bent backward, and 
the foreign body removed through the instrument. 

Occasionally, the condition is so urgent that to relieve 
the asphyxia, an opening must be made into the trachea 
below the point of obstruction, so that air may enter the 
lungs. This opening of the trachea is spoken of as tra¬ 
cheotomy. 

New Growths of the Larnyx. —The larynx, like the other 

organs in the body, may be the seat of benign or malignant 
growths. Probably the most common of the benign growths 
is the papilloma. These growths may be removed in three 
ways: through the larynx with the aid of the laryngeal 
mirror; from without by performing a thyrotomy (an in¬ 
cision through the thyroid cartilage of the larynx), or 
through a Jackson or Killian laryngoscope. The instru¬ 
ments used for their removal m^y be the snare, currette, 
forceps or galvano-cautery. 

Malignant Growths. —The symptoms of a cancer infil¬ 
trating the larynx may be very similar to those produced 
by the benign growths. Hoarseness, later loss of voice, 
respiratory difficulty, and pain are very common. Later 
when the growth extends and ulceration becomes evident, 
cough and pain on swallowing may be very evident. The 
only treatment is surgical. Either one-half or the entire 
larynx may be removed. 

Laryngectomy. —As the name implies the operation is one 
in which the larynx is excised. The operation itself is 
preceded by a tracheotomy. This may be done as a pre¬ 
liminary operation one day, the remainder of the operation 
being performed at another time, or the entire operation 
may be done at once. (See Tracheotomy). 

Operation. —The first part of the procedure is practically 
the same as tracheotomy except that the trachea is blocked 


LAVAGE 


by the use of a Hahns canula. This is done to prevent 
the blood from the laryngectomy from leaking down the 
trachea into the lungs. The canula is simply a tracheotomy 
tube which has been previously boiled and to which is at¬ 
tached and securely fastened a sponge squeezed dry and 
dipped in a io per cent, ether solution of iodoform. The 
sponge has been previously sterilized by soaking in a 2 5 
per cent, alcohol solution for several days. The tube with 
the sponge is introduced dry. After it is in the trachea from 
five to ten minutes there is usually enough moisture gener¬ 
ated to swell the sponge and block off the larynx above. The 
technique of the operation is unimportant. The Hahns canula 
is taken out after eight hours and the tracheotomy tube in¬ 
troduced. 

Post-operative Treatment. —Since the larynx has been re¬ 
moved and the pharynx has just been sutured, it is highly 
important that the patient be fed for the first few days by 
rectum. For the next four to five days feedings should 
be administered through the nose by catheter, and within a 
week, as a rule, the patient is able to swallow. Of course, 
in the beginning, only soft diet should be allowed. These 
patients are very much depressed because of the loss of voice, 
but they soon learn to whisper and make themselves under¬ 
stood. 


See Opium. 


LAUDANUM 


LAUGHING GAS 

See Anesthetics (Nitrous Oxide). 


LAVAGE 

Lavage is a method of washing out the stomach. 

Conditions in which a Lavage is most Commonly Used:— 

1. In acute gastric catarrh due to irritant, toxic, decom¬ 
posing substances, corrosive poisons or alcohol, etc. 

2. In chronic gastritis in which the stomach may be en¬ 
larged or atrophied with lessened motor power and secre¬ 
tions. 

3. In gastric carcinoma in which there is usually a les¬ 
sened amount or a total absence of hydrochloric acid. 

4. In persistent vomiting. 

5. In some cases of intestinal obstruction with fecal 
vomiting. 

6. In some cases of gastric ulcer, but here lavage is usually 
contraindicated. 

7. Sometimes following operations, before the patient is 


LAVAGE 


conscious, to thoroughly wash out the stomach and free it 
from ether, and bile, etc., so as to prevent later discomfort, 
nausea and vomiting. 

8. In dilatation of the stomach. 

Lavage may be given for the following reasons: i. To 

cleanse the stomach of undigested food, fermenting ma¬ 
terial, gases, toxic and poisonous substances or mucus. 

2. To cleanse, give comfort and prolong life in carcinoma. 

3. To stimulate peristalsis and the secretions in the 
stomach. 

4. To check hemorrhage. A very hot or very cold solu¬ 
tion is used with great caution. 

It is contraindicated (or should be given with great 
caution) in:—1. Ulceration with hemorrhage or following a 
recent and very severe hemorrhage from the stomach due to 
ulcer or carcinoma, etc. 

2. Uncompensated heart disease. 

3. Aneurysm of the thoracic aorta. 

4. Advanced pulmonary tuberculosis. 

5. Apoplexy. 

6. Cirrhosis of the liver causing obstruction of the portal 
circulation with varicose gastric veins which predispose to 
hemorrhage. 

7. Advanced arteriosclerosis. 

8. The habitual use is injurious and should be avoided. 

Method of Procedure. —In giving a lavage the following 

articles will be necessary: a dressing rubber and draw sheet 
to protect the patient and the bed; a kidney basin in case 
the patient vomits; gauze handkerchiefs to wipe away the 
mucus, etc., and to cleanse the tube; a paper bag for the 
soiled handkerchiefs; a large pitcher containing the solu¬ 
tion; a small pitcher for pouring; a pail for the return and 
a basin containing the stomach tube in cold water or ice. 
(A rubber catheter is used in giving a lavage to an infant.) 
This hardens the rubber, makes its passage easier and makes 
the taste and feeling less disagreeable to the patient. No 
lubricant is necessary or desirable, as any lubricant is dis¬ 
agreeable to the taste and increases the tendency to nausea 
and the normal mucus in the throat is usually a sufficient 
lubricant. This mucus is also increased when the tube is 
being passed. The tube used should be smooth and flexible, 
of medium size, but large enough to allow for the return of 
semi-solids without clogging. The end of the tube should 
be closed and rounded. The holes should be large and at 
the side, not at the end. 

The solution may be plain water or water containing salt 
or bicarbonate of soda (one dram to a quart) which softens 
and dissolves the mucus. In cases of poisoning a solution 


LAVAGE 


of potassium permanganate, tannic acid, or silver nitrate 
may be used. 

The temperature may be from ioo° to io6° F. when used 
for cleansing. It may be tested by pouring the solution over 
the back of the hand, as differences of one or two degrees 
have little effect. 

1 he quantity may be from two to six quarts, depending 
upon the condition. When given for cleansing the treat¬ 
ment is continued until the return is clear. 

The physical and mental condition of the patient. —Re¬ 
assure the patient about the total absence of danger, the cer¬ 
tain great relief which will follow, and the fact that the 
discomfort, which is greatly lessened by lack of resistance, 
is only temporary. Explain that at first there may be gag¬ 
ging and vomiting, and a choking sensation, but that there 
will be no difficulty in breathing when the tube is once in¬ 
serted properly. The insertion of the tube will be greatly 
aided if the patient swallows continually. The patient will 
probably struggle and invariably becomes cyanosed, but this 
is due to the choking and struggling and not to the tube 
having entered the larynx, which is possible under certain 
conditions, but not at all probable. 

If the patient is very nervous or irrational, assistance will 
be necessary and a mouth gag should be used to prevent the 
patient from biting the tube. 

The time and frequency of the treatments vary, but. they 
should not be given within from five to six hours after a 
meal. 

Before passing the tube, remove any false teeth or a plate 
which the patient may have. Remove all air from the tube 
by squeezing it between the fingers. It is not necessary to 
lubricate the tube (except when it is soft and recoils on 
itself or when the tissues are inflamed or ulcerated), as the 
mucus in the throat is sufficient and any lubricant tends to 
cause nausea. Occasionally it is necessary to paint sensitive 
parts with cocaine, but the patient soon becomes accustomed 
to the treatment. 

Ask the patient to hold the head slightly forward. Holding 
the head back makes the act of swallowing, and therefore 
the passage of the tube, difficult. Pass the tube along the 
curve of the hard and soft palate into the pharynx and 
esophagus but avoid touching the back of the pharynx, if 
possible, as this causes gagging. Normally the upper end 
of the esophagus is closed; this prevents the entrance of 
air into the stomach. Ask the patient to take deep breaths, 
to breathe slowly with the mouth open, to say a-a, then 
to swallow continually if possible. This flattens the tongue 
and opens the esophagus and starts the contractions of its 


LAVAGE 


muscles which carry the tube downward. When the tube 
enters the esophagus there may be a muscular spasm. Never 
try to force a passage, as this only increases the spasm. 
Stop, ask the patient to breathe more slowly and deeply, 
then if the patient swallows, the spasm relaxes. There are 
two other constricted portions of the esophagus which may 
make the passage difficult—one a little below the opening, 
the other where the muscles of the diaphragm form a sort 
of sphincter around it, as it passes through the diaphragm. 
If the patient simply keeps on swallowing, the tube will 
pass without difficulty. 

The length of the tube to insert varies with the patient. 
The esophagus begins at the sixth cervical vertebra and its 
lower end passes through the diaphragm opposite the tenth 
thoracic vertebra, to enter the stomach opposite the eleventh 
thoracic. In the adult the average length of the esophagus 
is about ten inches and the distance from the teeth to its 
opening is about six inches, making the distance from the 
teeth to the entrance of the stomach i 5}4 to 16 inches. The 
average length of the tube inserted is about 18 inches. 

When the stomach tube is in place, quickly fill the funnel; 
allow the water to run through, but before the funnel or 
tube is entirely empty refill it to prevent air from being 
drawn in. Never allow the tube to become empty, as this 
causes a very painful, dragging sensation in the stomach. 
Allow the fluid to run in slowly, never with force. When 
two or three funnelsful have been introduced, and before 
all the water has run through the tube, pinch the tube and 
invert the funnel over the pail and allow the fluid to siphon 
back. If you allow all the fluid to enter the stomach, leav¬ 
ing the tube empty, it will be difficult or impossible to ob¬ 
tain any siphonage. Never introduce more than one pint 
without siphonage, for in dilatation of* the stomach large 
quantities may be retained causing increased discomfort and 
a resulting paralysis of the walls of the stomach. Continue 
the treatment until the return is clear unless there is pain 
or blood in the return or the patient shows signs of ex¬ 
haustion; then discontinue and report the condition to the 
doctor. 

When the treatment is given for the first time, the patient 
may vomit, the vomitus returning around the tube. If 
vomiting continues, it is usually advisable to remove the 
tube and to reinsert it after vomiting has ceased. Use 
gauze to cleanse the secretions and vomitus from around 
the mouth. Sometimes the return from the lavage comes 
back around instead of through the tube. This may be 
because the tube is clogged with a semi-solid substance or 
filled with air. When clogged, pouring in another funnel of 


LEAD 


water may dislodge the substance, or it may be necessary 
to remove the tube and cleanse it. To expel air, pinch 
the tube and squeeze through the fingers in order to create 
a vacuum and obtain suction. It may also be because the 
tube is not in the stomach; the tendency of the stomach is 
to expel it. When there is difficulty in obtaining the return 
or the flow stops it may help to move the tube up or down 
slightly or to pour in more fluid until the patient complains 
of a sense of fullness. When a nurse is giving the treat¬ 
ment, however, it is safest to pour in only one extra fun¬ 
nelful. 

When the treatment is completed, pinch the tube tightly 
in front of the teeth (using gauze or the drawsheet) and 
withdraw it quickly to prevent food or fluid entering the 
larynx. Return the tube to the basin. Cleanse the patient’s 
mouth and face; remove the draping and make the patient 
comfortable. Remove and cleanse the utensils. A mouth¬ 
wash, particularly if the patient has been vomiting, will be 
very refreshing. 

The Care of the Stomach Tube. —When used for one 
patient only, the stomach tube need not be boiled after use 
as frequent boiling softens and renders it useless. It should 
be cleansed inside and out with cold water then with warm 
water and soap. If hung up to drain, spread the tube over 
a towel and do not allow it to bend at a sharp angle as this 
will cause the rubber to crack when dry. 

When the same tube is used for other patients it should 
be boiled for from one to three minutes. 

LAXATIVES 

See Cathartics. 

LEAD (PLUMBUM) 

Lead is a heavy metal which forms salts by combining 
with acids, many of which are used in medicine. 

Chronic Lead Poisoning 

Chronic lead poisoning is the most common form of 
poisoning by metals. It occurs particularly in workers 
who are forced to handle lead or its salts, such as white 
lead or type, continuously. Painters, type setters, plumbers 
and glaziers are frequently affected, the lead being absorbed 
from the skin, or from the stomach or intestines when it gets 
on the food from the hands. 

Occasionally, lead poisoning results from drinking water 
coming through lead pipes, or eating canned food from cans 
soldered with lead, or from food adulterated with lead; such 
as cakes colored with chromate of lead, etc. It often occurs 


LEAD 


from inhaling lead fumes in a room painted with lead paint, 
and from the absorption of ointments or solutions applied 
to wounds or ulcers. 

The symptoms appear very slowly and vary in different 
individuals. They result from the lead affecting the ali¬ 
mentary tract, the blood and the nerves. 

Symptoms. —i. Loss of appetite, nausea, metallic taste 
in the mouth and bad breath. 

2. “Lead line” on the gums. This is a dark blue line of 
lead sulphide which is deposited at the junction of the gums 
and teeth. It may be absent if the teeth are kept very clean. 

3. “Lead Colic” or painter’s colic. 

This is a very characteristic symptom, and usually ap¬ 
pears suddenly. The patient complains of severe cramp¬ 
like abdominal pains, usually beginning around the navel, 

and lasting for several days, after which they disappear but 

soon return. 

4. Obstinate constipation. 

5. Occasionally vomiting. 

6. Slow, strong pulse. 

Symptoms of the Nerves.— These appear later. 

1. Lead paralysis, lead palsy or painter’s palsy. The 

extensor muscles of both forearms usually become paralyzed, 
and the hands drop as a result of the contractions of the 
flexor muscles (“drop wrists’’). Other muscles may be 
similarly affected. 

2. Loss of sensation in areas of the skin. 

3. Sharp, shooting or boring pains around the joints 

(arthralgia). 

4. Rarely, blindness, from affection of the optic nerve. 

Treatment. —1. Individuals who are continually exposed 

to lead or its salts, can often avoid poisonous symptoms by 
keeping their hands and nails scrupulously clean, especially 
before eating, to avoid getting the lead particles in the 
mouth. They should move the bowels regularly, best by 
Epsom salts, and they should take dilute sulphuric acid in 
lemonade regularly. Their diet should contain plenty of 
milk. 

The patients suffering from an attack of chronic lead 
poisoning should be treated in the following way: 

1. The bowels should be moved regularly by magnesium 
or sodium sulphate, which also helps to neutralize the lead, 
forming lead sulphate, which is then excreted in the in¬ 
testines. 

2. Potassium iodide is given, which helps to eliminate 
the lead. 

3. The lead colic is best controlled by atropine. 

4. For the anemia, iron is given. 


LECITHIN 


5. The paralyses usually get well if carefully treated 
with electricity and massage. 

Uses 

Lead salts are used principally on ulcers and wounds, to 
contract the tissues, and to check bleeding. 

The lead acetate is occasionally given to check diarrhea. 

Preparations 

Lead Acetate (Sugar of Lead); dose 1 to 5 grains. 

Solution of Lead Subacetate (Liquor Plumbi Subacetatis) 

(Goulard’s Extract). 

This contains about 25 per cent, of lead subacetate. It 
should be diluted, about 2 drams being used to a pint of 
water. 

Dilute Solution of Lead Subacetate (Liquor Plumbi 
Subacetatis Dilutus). 

This contains 4 per cent, of the solution of lead subace¬ 
tate. 

Lead Plaster (Emplastrum Plumbi) (Diachylon Plaster). 

This consists of lead oxide, soap and water. 

Adhesive Plaster (Emplastrum Adhsesivum). 

This consists of rubber, lead plaster and vaselin. 

Soap Plaster (Emplastrum Saponis). 

This consists of soap, lead plaster and water. 

Diachylon Ointment (Unguentum Diachylon). 

This consists of lead plaster, olive oil and oil of lavender. 

LECITHIN 

Lecithin is a phosphorized fat. It consists of various 
salts of fatty acids such as oleic, stearic and palmitic acids 
combined with glycero-phosphoric acid and various protein 
substances. It is present in large quantities in nerve tis¬ 
sue. It is also present in various foods, especially in egg 
yolk and many vegetable foods. For medicinal purposes, 
it is made from egg yolk. 

Lecithin increases the nutrition of the body, though it is 
not nourishing in itself. It increases the number of red 
blood corpuscles and the hemoglobin. It is used principally 
as a tonic. 

It is given by the mouth in doses of 2 to 8 grains in 
pills, or hypodermically in doses of 15 minims, or in 15 
per cent, solutions in oil. 

Preparations 

Lecithin Solution (containing 1 grain of lecithin); dose 
1 dram. 

This is a 2 per cent, solution of lecithin in glycerin and 
alcohol. Its action and uses are the same as those of 
lecithin. 


LEECHING 


Lecithol; dose i dram. 

It is a 2 per cent, emulsion of lecithin in alcohol. It is 
obtained from the brains of hogs. 

LEECHING 

Leeching is a method of abstracting blood for the purpose 
of relieving local inflammation or acute congestion. It is 
often used in preference to the knife, which would leave a 
scar and might cause excessive bleeding. 

“The leech (hirudo) is an annelid worm with a sucker at 
each end of its body. At its mouth end there are three 
teeth arranged in a triradiate manner so that its bite con¬ 
sists of three short deep gashes radiating from a common 
center” (Bastedo). 

Although leeches may be found in the ponds and marsh¬ 
lands of America, in medicine the imported leech, chiefly 
from Sweden, is used. The Swedish leech is considered the 
best because it extracts about half an ounce of blood, while 
the American leech only extracts from one to two drams. 

The Action of the Leech. —The mouth of the leech, after 
its bloodsuckers are attached, secretes a substance (hirudin) 
which prevents the coagulation of blood so that it flows 
freely. After the leech is removed, some of this substance 
may remain in the tissues so that the hemorrhage may per¬ 
sist for some time. The effect produced is one of coun¬ 
terirritation as well as depletion. 

Conditions and Areas to which Leeches are most com¬ 
monly Applied: i. To the temple or nape of the neck in 
meningitis. 

2. To the temple, the forehead, in front or behind the ear 
for inflammation of the eye or ear. 

3. Behind the ear to relieve cerebral congestion. 

4. In the treatment of swollen joints after sprains, etc. 

Disadvantages in the Use of Leeches: 1. They may not 

be clean and in any case are not aseptic. 

2. They may wander and get in one of the body cavities, 
such as the ear, nose, vagina, etc. 

3. They remove an uncertain quantity of blood. 

4. They may have a bad psychic effect on a nervous pa¬ 
tient. 

When not in use the leech is kept in a jar of clean, fresh 
water, with a little sand in the bottom, and the jar must 
be tightly closed with a perforated cover. 

Method of Application. —The skin must be clean, shaved if 
necessary, and free from odors, or the leech will not take 
hold. Prepare the skin as for an incision but do not use 
disinfectants leaving an odor. Dry with a sterile wipe. 
Be sure the leech attaches itself to the desired spot only. 


LEPROSY 


To insure this place it in a glass tube so that the head comes 
first—the head is recognized by its three-cornered mouth. 
Hold the tube over the spot and do not remove it until the 
leech has taken hold, so as to prevent it from migrating. 
It must not be placed over a vein but over a spot where 
pressure may be made if necessary to control bleeding. 
Leech-bites make small, permanent scars, so they are not 
usually applied on the face or other conspicuous parts. 

If the leech will not take hold, it may be coaxed or stimu¬ 
lated by placing a little sweetened milk or water on the spot 
or by pricking the spot with a sterile needle and drawing a 
drop of blood. Gently stroking the back of the leech some¬ 
times helps. Putting the leech in very cold water for a 
minute or two is one of the very best ways of arousing its 
appetite. The patient should never be left alone because of 
the wandering habits of the leech. For safety, the cavities 
of the nose and ears, etc, may be plugged with cotton, espe¬ 
cially the ear when the application is near the ear. To 
prevent the uncomfortable sensation of contact with the body 
of the leech, a layer of gauze is placed between it and the 
skin after it has taken hold. 

Removal of the Leech. —The leech must never be forcibly 
removed or its teeth or suckers will remain and cause con¬ 
tinued bleeding and inflammation in the part. (In any case 
the bleeding may persist, so it is wise to protect the bed 
before making the application.) When it has drawn enough 
blood, the leech may easily be removed by sprinkling it with 
a little salt or by squeezing its head. When satisfied, it 
will drop off of its own accord. On removal it should be 
destroyed immediately. Cover it with salt and then burn. 
Never use it a second time. Never throw it down the drain 
pipe or in the garbage tin alive. After removal, if there is 
no hemorrhage, apply a sterile dressing. If bleeding con¬ 
tinues, and is prolonged, it may exhaust the patient, so it 
is necessary to control it. It may be controlled by apply¬ 
ing a sterile dressing and a tight bandage with pressure or 
by astringents or styptics such as adrenalin, alum or tannic 
acid or by applying ice compresses with a tight bandage. 


LEPROSY 

Leprosy is a disease due to a germ which is probably as 
closely allied to the germ of tuberculosis as the paratyphoid 
germ is to the typhoid germ, or as the bovine tuberculosis 
germ is to the human tuberculosis germ. Its incubation 
period is unknown but is supposed to be a matter of many 
years; its prodromal period is perhaps one to two years. 
Recovery is very rare, so that the fastigium usually cor- 


LEUCORRHEA 

responds with the remainder of the patient’s life, which 
may be many years. 

Leprosy, apparently, begins in the nose, with ulceration, 
etc. It may then affect chiefly the skin (tubercular form), 
or chiefly the nerves (anesthetic form) or occur in mixed 
form. 

It is of interest as being one formerly widespread dis¬ 
ease which has been banished by segregation; the leprosaria 
of Europe several centuries ago being more numerous than 
our tuberculosis sanatoria are now. 

It is of interest also because of its relatively non-infectious 
character and the intimate and prolonged character of the 
contact usually necessary to its spread. 

LEUCORRHEA 

See Menstruation. 

LEVANT WORM SEED 

See Santonica. 

LICE 

Three forms of lice are common, in the human, the head 
louse, the body louse and the pubic louse or “crab.” They 
also have the four stages from egg to adult and, in this 
country, seem to be restricted to annoyance of their host, 
although if once infected they may carry, by biting, typhus 
fever, trench fever and perhaps relapsing fever. 

The head louse fastens its eggs to the hairs and although 
a mixture of equal parts of kerosene and olive oil, soaked 
into the hair over night, will kill all stages, the egg shells 
still remain, and are best removed by soaking in warm vine¬ 
gar and then using a fine-toothed comb. 

Body lice, on stripping the infested person, will be found 
chiefly along the seams of the clothing. A thorough bathing 
of the infested person, with sterilization of the clothing 
(baking, steaming, gasoline, etc.), will secure their riddance. 

“Crabs” cling close— “blue mass” (mercury ointment) or 
strong disinfectant solutions will dislodge them, but shaving 
the affected parts is almost a prerequisite. 

Fleas, leaving infected rats to bite the human, are the 
chief means of carriage of the bubonic plague. 

Bedbugs, by biting an infected person, may carry on their 
mouth-parts some of the infections to their next victim, but 
no particular disease has been associated with them as yet. 

Wood-ticks carry the Rocky Mountain spotted fever, a very 
serious and fatal disease found in a rather limited area in 
Montana and vicinity. 

The itch-mite, about Vioo of an inch in diameter, is re- 


LIQUID PETROLATUM 


sponsible for scabies or “the itch.” The female burrows 
into the skin to lay its eggs and lies at the bottom of the 
burrow. These eggs develop and the impregnated females 
move on to make new burrows in the same person or in a 
new victim who comes too closely into contact with the first. 

This disease, an exceedingly irritating and, if neglected, 
possibly fatal disease (fatal from irritation, sleeplessness, 
infection of the scratched areas, etc., is readily cured by 
treatment with sulphur ointment. Obstinate cases may be 
painted with Balsam of Peru. 

LICORICE 

See Glycyrrhiza. 

LIGATURE 

See Hemorrhage. 

LIME 

See Calcium. 

LINIMENTS 

Liniments are liquid or soft preparations of drugs which 
are applied by rubbing on the skin. The drug is usually dis¬ 
solved in alcohol or in an oily substance. 

Liniments are usually applied for their soothing effect. 
They should be applied on a piece of flannel or lint which 
keeps the skin warm, prevents evaporation of the liniment 
and thereby helps the action. Many liniments are applied 
by vigorous rubbing. Whatever effect is then produced is 
due principally to the vigorous massage and very little, if 
any, to the liniment itself. 

LINSEED (LINUM) 

Linum (linseed or flaxseed) is the dried ripe seed of 
Linum usitatissimum or the flax plant. 

Flaxseed meal is the ground dried seeds and is used prin¬ 
cipally as a poultice. The seeds themselves are often given 
in the form of an infusion (flaxseed tea) to relieve bron¬ 
chitis, painful urination and painful defecation. 

LIQUEURS 

See Alcohol. 

LIQUID PETROLATUM (MINERAL OIL) 

Liquid Petrolatum, Mineral Oil or Liquid Paraffin is a 

heavy oily substance which is obtained from petroleum oil. 
Chemically it belongs to the group of hydrocarbons. It is 
on the market under various names: Liquid Vaseline; 
Liquid Albolene, etc. Russian mineral oil is the same 


LIQUOR ANTISEPTICUS 

substance obtained from Russia, but is much heavier than 
the American product. 

Applied locally mineral oil is bland and soothing to the 

skin and mucous membranes. 

When taken internally it is not absorbed. When it enters 
the intestines it becomes mixed with the intestinal contents 
which it protects from the action of the digestive juices. 
The water of the intestinal contents is therefore not absorbed 
and the mass of feces gradually becomes increased. This 
distends the intestines and bowel movements result. At the 
same time it lubricates the mucous membrane of the in¬ 
testines. 

Mineral oil is used as a laxative especially in chronic con¬ 
stipation; which is frequently due to a weakened condition 
of the intestinal muscles or to delicate kinks or adhesions 
of the intestines. 

It is given in doses of 4 to 8 drams, two or three times 
a day. 

It occasionally causes nausea and it frequently has a 
tendency to ooze from the rectum between stools. 

Administration. —Liquid Petrolatum or mineral oil should 
be given about two or three hours after meals, undiluted. 
As it has a bland taste, which patients usually do not like, 
it should be flavored with some aromatic substance such as 
peppermint or cinnamon water. 

LIQUOR ANTISEPTICUS 

See Boric Acid. 


LISTERINE 

See Boric Acid. 

LITHIUM SALTS 

See Saline Diuretics, and Saline Purgatives. 

LIVER AND GALL-BLADDER 

The liver is the largest gland in the body, weighing 
ordinarily from fifty to sixty ounces. It measures eight 
to nine inches from side to side, six to seven inches from 
front to back, and four to five inches from above downward 
in its thickest part. It is a reddish brown organ, placed 
directly below the diaphragm, in front of the right kidney, 
the pyloric end of the stomach, and the upper part of the 
ascending colon. The upper convex surface fits closely into 
the under surface of the diphragm. The under concave 
surface of the organ fits over the right kidney, the upper 
portion of the ascending colon, and the pyloric end of the 
stomach. 


LIVER, SURGICAL CONDITIONS OF 

The liver is connected to the under surface of the dia¬ 
phragm, and the anterior walls of the abdomen by five liga¬ 
ments, four of which are formed by folds of peritoneum, and 
the fifth, or round ligament, is a fibrous cord resulting from 
the atrophy of the umbilical vein of intra-uterine life. 

The gall-bladder.— The gall-bladder is a pear-shaped sac 
lodged in the gall-bladder fissure on the under surface of 
the liver, where it is held in place by connective tissue. It 
is about four inches long, one inch wide, and holds about 
ten drams. 

LIVER, SURGICAL CONDITIONS OF 

The diseases which commonly involve the liver from a 
surgical standpoint are injuries to the liver, abscesses of 
the liver and cirrhosis of the liver. 

Injuries to the Liver. —The liver may be injured by direct 
or indirect violence; it may be torn, with an ensuing hem¬ 
orrhage. This must be treated by immediate laparotomy, 
packing the tear with gauze, or by suturing the tear of the 
liver with mattress sutures, employing a round, non-cutting 
liver needle. The suture material is usually chromic catgut. 

Abscess of Liver. —This may be of pyogenic origin, or the 
direct result of amebic dysentery. These abscesses may be 
opened and drained directly through the abdomen, or if the 
abscess is high, an operation may be performed through the 
posterior lateral area of the chest. The parietal and visceral 
pleura are sutured together, and after adhesions have taken 
place, so as to seal off the pleural cavity, the liver is drained 
through this area. In this way no pus flows through the 
abdominal or peritoneal cavity, or through the pleural cavity. 
This operation is done in two stages: the first being a partial 
resection of the rib, with the suturing of the parietal and 
visceral pleura; the second is the drainage of the abscess 

through the area of the adhesions. 

Cirrhosis of Liver. —As this condition is associated with a 
filling of the peritoneal cavity with fluid (ascites), and as it 
is presumably due to an obstruction of the portal circula¬ 
tion, an attempt is made to establish a collateral circulation 
by the Talma operation (omentopexy). 

Twenty-four hours prior to operation, an ordinary para¬ 

centesis abdominalis is done. The patient is then operated 
upon, and a portion of the omentum brought through the 
anterior abdominal walls in the m'id line and sutured to 
the subcutaneous tissues. In this way the omental veins 

will establish collateral circulation with the internal mam¬ 

mary vein, thereby lessening the strain of the portal system. 

The one important factor in post-operative treatment is 
when a patient strains, the abdomen should be firmly held 


LOBELIA 


so as to prevent further evisceration of the abdominal con¬ 
tents along with the omentum. 

And see Gall-stones. 


LOBELIA 

Lobelia is obtained from tr<® leaves and tops of the 
Lobelia inflata or Indian tobacco; its active principle is 
an alkaloid, lobeline. 

When taken internally, lobelia produces the following 

effects: 

1. It increases the secretions of the stomach and intes¬ 
tines, often causing nausea and vomiting, and occasionally 
frequent movement of the bowels. 

2. It lessens the contractions of the involuntary muscles 
of the bronchi. 

3. It increases the secretions. 

4. The pulse is usually slower, but soon becomes rapid 
and weak. 

5. The breathing is somewhat slower. 

Poisonous Effects 

An overdose of lobelia usually causes the following 
symptoms: 

1. Nausea, and profuse vomiting. 

2. Occasionally frequent movements of the bowels. 

3. Great weakness and relaxation of the muscles. 

4. Collapse (rapid, thready pulse, slow, shallow breathing, 
cold, moist skin, and dilated pupils). 

5. Convulsions, stupor, coma and death from paralysis of 
the breathing. 

Uses 

Lobelia is occasionally used to relieve the spasmodic cough 
of whooping cough and asthma; but because of its dangerous 
poisonous effects, its use has mostly been given up. It is 
occasionally used in the form of an infusion, to relieve 
poison ivy rash. 

Preparations 

Fluidextract of Lobelia; dose 1 to 5 minims. 

Tincture of Lobelia; dose 10 to 60 minims. 

LOCOMOTOR ATAXIA 

See Tabes Dorsalis. 

LOGWOOD 

See H^ematoxylon. 


See Mercury. 


LOTIO FLAVA 


LUMBAR PUNCTURE 


LOTIO NIGRA 

See Mercury. 

LOZENGES 

Lozenges are flat discs consisting of a drug made up with 
sugar or tragacanth or any demulcent substance. 

LUGOL’S SOLUTION 

See Iodine. 

LUMBRICIDES 

Lumbricides are drugs which destroy • round worms. 
Round worms are small, cylindrical worms which are often 
found in the small intestine of children. 

See Anthelmintics. 

LUMBAR PUNCTURE 

Lumbar puncture consists in the introduction of a suitable 
needle into the subarachnoid space of the spinal canal and 
the withdrawal of cerebrospinal fluid for diagnostic oi 
therapeutic purposes. It also consists in the withdrawal of 
fluid for the purpose of injecting serum as a therapeutic 
measure and drugs to produce spinal anesthesia. 

Dangers involved in a Lumbar Puncture. — i. In opera¬ 
tions or in a lumbar puncture, the drainage or escape of 
cerebrospinal fluid may be so great as to deprive the medulla 
of its water-cushion, causing it to rest directly on the 
uneven bony surface of the skull. The resulting irritation 
may cause convulsions and may even interfere with the 
vital functions of the heart, respirations and vasomotor 
systems. There are reported cases of unconsciousness, death 
from respiratory paralysis, pain and partial paralysis result¬ 
ing from this treatment. 

2. A sudden fall in pressure may result in very dangerous 
circulatory disturbances which may prove fatal. 

3. Injury to the spinal cord may result. 

4. Infection may be carried in. 

5. Injury to the cauda equina, shown by twitching of the 
muscles of the lower extremity, may occur. 

Conditions and Purposes for which a Lumbar Puncture 
is Performed: 1. To relieve pressure in hydrocephalus, in 
tuberculous and syphilitic meningitis, in uremia, in convul¬ 
sions in children and in epidemic meningitis due to the 
meningococcus. In epidemic meningitis, sometimes the 
canal is drained, that is, the fluid is allowed to flow until 
the pressure is so reduced that only three or four drops 
come per minute. The canal is then irrigated by introduc- 


LUMBAR PUNCTURE 


ing the same amount of normal saline and again draining. 
Then anti-meningitis serum, warmed to body temperature, 
is injected very slozvly under the least possible pressure. 
The dose of serum is usually 20 c.c. or a little less than the 
amount of fluid withdrawn, which may be 25 c.c. The dose 
may be repeated every twelve hours or even every eight 
hours, and is repeated until the spinal fluid is clear. 

2. Fluid is withdrawn for the purpose of injecting tetanus 
antitoxin. 

3. Fluid is withdrawn for diagnostic purposes. 

4. In syphilis involving the nervous system fluid is with¬ 
drawn for the purpose of injecting serum obtained from 
the blood after the patient has received an intravenous 
injection of salvarsan. 

A lumbar puncture is contraindicated in a brain lesion or 
suspected brain tumor. If fluid is necessary for diagnosis not 
more than four to six c.c. are withdrawn and this is not 
done unless absolutely necessary. 

Method of Procedure. —The treatment must be carried out 
with the strictest aseptic precautions. 

Watch the patient’s color, pulse and respiration during 
and after the treatment. 

When the patient’s condition permits, he may be told 
the nature of the treatment and that it involves only slight 
pain. The pain of the skin puncture is prevented by a 
local anesthetic of cocaine; the passage through the dura 
and the stretching of the periosteum sometimes causes con¬ 
siderable pain. 

The position of the patient is important. He should lie 
on his left side near the edge of the bed with his knees 
drawn up as near as possible to his chin so as to separate 
the vertebrae. The upright position, with the patient leaning 
forward, his arms resting on a chair or bed rest, is some¬ 
times used, but this position is said to be inadvisable because 
it is difficult to measure the pressure of the spinal fluid, and 
sudden falls of pressure in the spinal canal, as previously 
stated, are likely to set up dangerous circulatory changes 
(Wood). 

The puncture into the subarachnoid space is usually made 
in the interspace between the third and fourth lumbar 
vertebrae or between the fourth and fifth lumbar vertebrae. 

The skin is carefully disinfected and the area draped 
with sterile towels. The doctor wears sterile gloves. All 
the articles used must be sterile. A hypodermic needle and 
syringe loaded with cocaine, two lumbar-puncture needles, 
three sterile test tubes, sterile cotton, a sterile dressing and 
adhesive will be required. Sometimes a dry sterile aspirat¬ 
ing syringe is required. 


LUTEIN 


The patient must remain perfectly quiet during the treat¬ 
ment. 

After the treatment he should be kept quiet in bed for at 
least twenty-four hours in order that equal pressure may 
be established in the cerebrospinal cavity and no unpleasant 
symptoms result from the procedure. 

See Cerebrospinal Fluid. 

LUNGS 

The lungs are cone-shaped organs which occupy almost all 
of the cavity of the thorax that is not taken up by the heart, 
the large blood-vessels, the lymphatics, and the esophagus. 
Each lung presents an outer surface which is convex, a base 
which is concave to fit over the convex portion of the 
diaphragm, and a summit or apex which rises half an inch 
above the clavicle. On the inner surface is a vertical notch 
called the hilum, which gives passage to the bronchi, blood¬ 
vessels, lymph-vessels, and nerves. 

The right lung is the larger and heavier; it is broader 
than the left, owing to the inclination of the heart to the 
left side; it is also shorter by one inch, in consequence of the 
diaphragm rising higher on the right side to accommodate 
the liver. The right lung is divided by fissures into three 
lobes, upper, middle, and lower. 

The left lung is smaller, narrower, and longer than the 
right. It is divided into two lobes, upper and lower. The 
front border is deeply notched to accommodate the heart. 

Pleura. —Each lung is enclosed in a serous sac, the pleura, 
one layer of which is closely adherent to the walls of the 
chest and diaphragm (parietal); the other closely covers the 
lung (visceral). The two layers of the pleural sacs, moistened 
by serum, are normally in close contact; they move easily 
upon one another, and prevent the friction that would other¬ 
wise occur between the lungs and the walls of the chest 
with every respiration. Inflammation of the pleura is called 
pleurisy. 

Mediastinum. —The mediastinum is the space left in the 
median portion of the thorax between the pleural sacs. It 
extends from the sternum to the spinal column, and contains 
a portion of many organs, i.e., the trachea, esophagus, great 
vessels connected with the heart, lymph-nodes, thoracic duct, 
and various nerves. 

LUTEIN 

This is a substance made from the corpus luteum of the 
ovaries of the cow. It is used to relieve painful and scanty 
menstruation and the nervous symptoms usually associated 
with this condition. 


LYCOPODIUM 


LYCOPODIUM 

This consists of the spores of Lycopodium clavatum or club 
moss. It is used principally as a soothing dusting powder 
and in the making of pills. 

LYSOFORM 

Lysoform is a combination of lysol and formaldehyde 
which is used as a disinfectant in 5 to 10 per cent, solutions. 

LYSOL 

Lysol is a 50 per cent, solution of cresols dissolved in 
soap. It forms a frothy solution in water and is used for 
douches and other irrigations in J4 to 1 per cent, solutions. 


M 


MAGENDIE’S SOLUTION OF MORPHINE 

This is a i to 30 solution of morphine sulphate (or 16 
grains to the ounce). This is a solution which is very 
commonly used for hypodermic administration. It should 
always be fresh, as a fungus often grows in old solutions, 
and makes it unfit for use, of it may change the morphine 
to apomorphine. 

MAGNESIUM 

The preparations of magnesium act similarly to those of 
calcium. 

1. They neutralize the acid in the stomach. 

2. They are not readily absorbed, passing into the intes¬ 
tines, where they act as cathartics, causing frequent fluid 
stools. 

3. The small amount of magnesia that is absorbed increases 
the alkaline reaction of the blood. 

Preparations 

The preparations of magnesium, which are principally used 
to neutralize the acid in the stomach, are: 

Magnesium Oxide (calcined or light magnesia); dose 
5 to 60 grains. 

Milk of Magnesia; dose 1 to 4 dram 9 . 

This is a proprietary preparation containing magnesium 
hydrate. It is used as an antacid and cathartic. 

Magnesium Sulphate (Epsom salt); dose half a dram to 
one ounce. 

This is soluble in parts of water. 

Magnesium sulphate is very commonly used. It has a 
very unpleasant taste and is best given in seltzer or vichy. 

Large doses produce very frequent stools, with a good 
deal of griping. (See Saline Purgatives.) 

MALARIA 

Malaria is a disease caused by a unicellular organism, a 
protozoon called the Plasmodium malariae. This organism 
is injected into the blood of the patient when bitten by a 


MALE FERN 


species of mosquito, the anopheles. The organisms then 
enter the red blood corpuscles, where they grow and develop 
into other similar organisms in 48 or 72 hours, depending 
on the type of organism. At the end of this time, the red 
blood corpuscles burst and the newly formed malarial para¬ 
sites and poisonous substances, together with the hemoglobin 
of the red blood corpuscles, are thrown into the blood. 

As a result of the sudden destruction of a large number 
of red blood corpuscles, and the liberation of poisonous 
substances, the patient has a chill. The violent muscular 
contractions which are thus produced, elevate the tempera¬ 
ture several degrees, and since this temperature is excessive, 
it is followed by sweating, which gradually reduces it to 
normal again. 

These chills, fever and sweats occur every other day, if 
the organism which causes these symptoms is the tertian 
type, or the one which develops in 48 hours. They occur 
every third day, if the organism is the quartan type or the 
one which develops in 72 hours. In other cases, the chills, 
fever and sweats occur every day. This is due to the fact 
that the patient is infected with two types of tertian organ¬ 
isms, each one developing every 48 hours, but on alternate 
days. The attacks always occur regularly at about the same 
time during the day. 

See Quinine; and Mosquitoes. 

MALE FERN (ASPIDIUM) 

Male fern or filix mas is obtained from the underground 
stems of the Dryopteris filix mas and of Dryopteris mar- 
ginalis. The chief active principle is aspidin. 

When taken internally, male fern has a very unpleasant, 
nauseous taste, and it destroys tape worms and hook worms. 

Poisonous Effects 

In some individuals, if large doses of the drug are given, 
it may be absorbed and cause: 

1. Abdominal pain. 

2. Nausea, vomiting and diarrhea. 

3. Muscular twitchings. 

4. Convulsions, collapse, coma, and death. 

Administration 

The oleoresin or fluidextract is usually given, either in 
pills, capsules or as a suspension in mucilage. 

Preparations 

Oleoresin of Aspidium; dose % to 2 drams. 

Filmaron; dose 2V2 drams. 


MANNERISMS 


This is a substance obtained from an ethereal extract of 
aspidium. It is said to be safer than aspidium. 

This is a io per cent, solution of filmaron in castor oil. 
See Anthelmintics. 

MALT 

Malt is a barley grain made to grow artificially. The 
growth is then stopped by means of heat. During this 
growth the starch contained in the barley is changed to 
sugar by means of diastase, a ferment which is contained 
in the barley grain. Malt which contains this ferment, is 
often given to help the digestion of starch. Many of the 
preparations used contain no diastase and produce no di¬ 
gestive effects; though they are easily digested foods. Many 
of the malt extracts contain alcohol, and are therefore similar 
to beer or stout. 

Preparations 

Extract of Malt; dose 4 ounces. 

This is an extract of malt in syrup. 

Maltine, Maltzyme and others. 

MANGANESE 

Manganese is a metal. Many of its preparations are 
occasionally used in medicine. It is found in the body 
in the red blood corpuscles, the hair and bile, usually together 
with iron. Some of its preparations, especially potassium 
permanganate, are used as an antiseptic. 

It is said to increase nutrition and is frequently given 
together with iron. It cannot replace iron, however, as it 
does not help to form hemoglobin. 

Preparations 

Manganese Sulphate; dose 2 to 8 grains. 

Manganese Hypophosphite; dose 3 grains. 

Potassium Permanganate; dose to 3 grains. 

This preparation gives off oxygen; it is often given in 
cases of poisoning from various drugs. For example—in 
morphine poisoning it is given to neutralize the morphine 
by the oxygen which the potassium permanganate liberates, 
which then combines with the drug and makes it inactive. 

It is also used as an antiseptic, acting in a similar manner, 
the oxygen destroying the bacteria. 

MANNERISMS 

Mannerisms are peculiarities of conduct shown in the 
ordinary simple movements or activities: grimaces, queer 
or bizarre movements, baby talk, etc. These also may be 
the responses to hallucinations. 


MASSAGE 


MASSAGE AND MOVEMENTS * 

By Norman D. Royle, M.B. 

(Orthopedic Surgeon to the Lewisham Hospital, Sydney, etc.) 

MASSAGE 

Definition. —Massage is the scientific manipulation of the 
tissues of the body; it is not merely rubbing, but consists 
of definitely executed movements, designed to bring about 
therapeutic changes. 

Effects of Massage. —1. On the Nervous System. —Mas¬ 
sage has a stimulating effect on the nervous system, when 
brisk and vigorous procedures are employed. Light touch 
and stroking movements, on the other hand, have a sooth¬ 
ing effect and tend to alleviate pain. 

2. On the Muscular System. —Massage acts as a sub¬ 
stitute for exercise of the muscular system, by increasing 
the blood supply, and by removing the waste products of 
fatigue. The tone of the muscles is also improved by its 
stimulating effect on the motor nerves. 

3. On the Circulation.—Massage increases the rate of 
circulation of the blood in the parts manipulated. The 
venous and lymphatic vessels are more speedily emptied 
and thus allow a freer access for the arterial blood. This 
is accompanied by a reddening of the surface and an in¬ 
crease in the temperature of the part. The dilatation of the 
superficial vessels, produced by massage, relieves congestion 
in the deeper structures; while the absorption of adhesions 
and softening of scar tissue are the results of the increased 
vascularity and the systematic manipulations. 

General Directions. —The nurse should obtain instructions 
from the attending physician or surgeon, before commencing 
massage, and report any symptoms arising during treatment. 

The patient should be placed in a comfortable position and 
only the parts under treatment should be exposed. When 
a limb is to be treated the parts should be placed in a position 
of rest and the muscles relaxed. If the patient’s skin is 
moist, the use of a dusting powder is advisable as the hands 
tend to adhere to the surface of the body and the treatment 
may cause unnecessary pain. The duration of the treatment 
varies with the case, but should not extend over half an 
hour except when general massage is prescribed. In ordi¬ 
nary cases from ten to twenty minutes is sufficient, but, when 

* From “Surgical Nursing and After-Treatment,” by H. 
C. Rutherford Darling, M.D., M.S. (Lond.), F.R.C.S. (Eng.), 
etc. Published by J. and A. Churchill, London. 

By Courtesy of the Author and Publishers. 


MASSAGE 


passive and active movements are also administered the 
session may be a little longer. The hands should be kept 
soft and dry. 

The Procedures of Massage. —The procedures of massage 
are varied, but may be classified as follows: 

1. Touch. 

2. Stroking (Effleurage). 

3. Kneading (Petrissage). 

4. Percussion (Tapotement). 

5. Vibration. 

Other groups are described and there are groups which do 
not admit of classification. The nurse should remember, 
also, that it is not necessary to follow slavishly the set 
descriptions of procedures; she may, after mastering the 
rudiments, evolve movements in which she is more proficient. 

1. Touch. —This procedure consists of slight pressure with 
the tips of the fingers or the palmar surface of the whole 
hand applied to different parts of the body. 

2. Stroking. —Stroking is touch combined with motion. It 
may be exceedingly light, just as if one were endeavoring to 
touch the superficial hairs of the skin and nothing else; or 
it may be applied with varying degrees of pressure. It may 
be done with the tips of the fingers or with the palmar 
surface of the hand, moulded to the parts under treatment. 
Except in special circumstances the stroking is carried out in 
the direction of the venous flow. Friction is a stroking 
movement executed somewhat rapidly and with a greater 
degree of pressure. The pressure is varied, being light over 
bony prominences and heavy over large fleshy masses. 

3. Kneading. —This procedure is carried out by the nurse 
grasping the tissues in her hand and applying intermittent 
pressure. Kneading may be superficial or deep. In the 
superficial variety the skin is grasped between the thumb and 
the second and terminal phalanges of the first finger, lifted 
off the underlying tissue, compressed and then released in 
that order. The movement progresses in a given direction. 
In deep kneading, the muscle groups are compressed be¬ 
tween the ball of the thumb and the outer side of the hand, 
while the fingers assist by adapting themselves to the tissues 
and making the compression more complete. Kneading may 
also be carried out by applying the palmar surface of both 
hands to the parts under treatment, and a slight rolling 
movement may be combined with the compression. The 
movement advances in the long axis of the muscles. 

4. Percussion. —This is carried out by striking the parts 
to be treated with the backs of the fingers, the inner border 
of the little finger striking first and the adjacent fingers 
following in rapid succession. In this movement the fingers 


MASSAGE 


all seem to strike simultaneously. Percussion may also be 
of a hacking movement, carried out by striking the part with 
the ulnar border of the hand. Both hands are used alter¬ 
nately and the movements follow one another rapidly. 

5. Vibration.—This is a procedure applied to special parts 
and consists in applying the whole hand and making it 
tremble so as to produce a vibration in the patient’s body. 

Massage as a Therapeutic Agent. —Massage is used in the 
treatment of sprains, dislocations, fractures and other surgical 
affections. Abdominal massage may be used to improve 
digestion and alleviate constipation, while general massage 
may be used in conditions of general weakness. 

Sprains.—Recent sprains may be treated with light mas¬ 
sage to reduce the swelling and limit the effusion. It is 
advisable to use stroking movements (with the tips of the 
fingers) in commencing the treatment. As the tenderness 
disappears the manipulations may become more vigorous and 
passive and active movements should be added. 

Dislocation. —After reduction of a dislocation gentle mas¬ 
sage and movements tend to alleviate the pain and promote 
the absorption of the inflammatory products. Postpone more 
vigorous manipulations until the torn ligaments have healed. 
In performing passive movements after a dislocation, it is 
quite sufficient to do one or two thorough movements. 

Fractures.—In recent fractures only the gentlest massage 
should be used for some days. Light touch and stroking 
movements have a remarkable power of relieving the pain 
occasioned by the fracture. As healing takes place stroking, 
superficial kneading, and gentle passive and active movements 
are introduced; and finally, when union is complete, vigorous 
manipulations and movements both active and passive are 
used to restore the functional activity of the part. It is not 
always necessary to remove the splints in commencing treat¬ 
ment by massage, as benefit may be derived from manipu¬ 
lating the exposed parts above and below the seat of fracture. 

Pott’s and Colies’ Fractures. —On account of the dis¬ 
ability and deformity following these fractures massage is 
usually employed from the beginning of treatment. Passive 
and active movements of the ankle and toes in Pott’s frac¬ 
ture, and of the fingers and wrist in Colies’ fracture, should 
be used early to ensure a good result. Touch, stroking and 
superficial kneading are the procedures most suitable for the 
immediate treatment. 

MOVEMENTS 

Movements in surgical nursing may be passive or active— 

Passive movements are performed by the nurse on the 
patient’s passive body; in these, joints are moved and liga- 


MASSAGE 


ments, tendons, and tissues are stretched. Passive movements 
are more or less mechanical in their action, though in some 
cases, as in a recent fracture, they may be employed to 
bring about gentle exercise of the muscles as well. 

•Active movements are those in which the patient’s volition 
is called upon to bring about contractions of the muscles 
of the body and so to perform movements of various kinds. 

Active movements may be divided into— 

Free movements. —These are carried out voluntarily by 
the patient, without assistance or resistance. 

Resistive movements. —In these the patient’s movements 
are opposed by the nurse; and they may be concentric or 
eccentric. In the concentric form, the patient commences 
with the muscles to be exercised in a position of relaxation 
and contracts them against the resistance of the nurse. In 
the eccentric form, the patient begins with the muscles al¬ 
ready contracted and endeavours to maintain the contrac¬ 
tion which the nurse relaxes. As for example, the muscles 
on the anterior aspect of the upper arm bend the elbow so 
that the hand moves towards the shoulder. If the patient 
bends the elbow while the nurse resists, the movement is 
concentric; but if the elbow is bent and the nurse straightens 
it against the patient’s resistance, the movement is eccentric. 

Minimum movements. —In surgical nursing, cases of pare¬ 
sis occur in which the patient is able to perform neither 
ordinary active movements nor exercises against the least 
resistance; but he may be able to bring about a small con¬ 
traction of a muscle group under suitable conditions. These 
conditions are: a reduction to a minimum of the forces and 
factors which tend to interfere with the movements of the 
muscles. Friction, gravity and mechanical interference with 
the line of action of a muscle may be mentioned as examples. 
Friction may be reduced by using a large sheet of smooth 
cardboard placed on an even surface and covered with ordi¬ 
nary boracic powder. A patient with paresis of the hip 
muscles, for example, is put in the recumbent attitude with 
the lower limb supported on cardboard. 

For flexion, the patient draws the heel upwards towards 
the trunk; for abduction and adduction, the limb is extended 
and the patient glides it over the smooth surface of the card¬ 
board. The action of gravity is minimized by supporting the 
part to be exercised on a horizontal surface, or by using 
the ligaments of joints to support the weight of the distal 
part of the limb. In paresis of the wrist, for example, ordi¬ 
nary bending and straightening may be impossible; but turn 
the hand so that the thumb is uppermost and the weight is 
supported by the lateral ligament and movement may be 
appreciable. As the muscles gain in strength the difficulty 


MASSAGE 


of this movement may be increased by turning the thumb 
outwards for flexion {i.e., bending) and inwards for exten¬ 
sion ( i.e ., straightening the wrist). An example of dealing 
with the mechanical interference to the line of action of a 
muscle will be given under Active Movements of the Hand. 


Passive Movements of the Various Joints 

Fingers.—The nurse, grasping the patient’s hand in her 
left hand, alternately bends and straightens each finger. 
Each joint of each finger is similarly treated and in addition 
a circular movement of the whole finger on the hand may 
be performed. In all passive movements the severity of the 
treatment varies with the indications and the nurse should 
obtain explicit instructions from the surgeon. 

Wrist.—Grasp the patient’s wrist with the left hand and 
carry out bending, straightening and lateral movements. 

Forearm.—Grasp the patient’s elbow with one hand and 
obtain a handshake grasp with the other. The patient’s hand 
is then twisted alternately outwards and inwards. A firmer 
grasp is obtained by extending the fingers upwards on the 
patient’s wrist. The movements should be executed slowly 
and deliberately. 

Elbow.—Grasp the patient’s upper arm with one hand and 
the forearm with the other—bend and straighten alternately. 

Shoulder.—This is a difficult joint to manipulate, as the 
patient usually performs movements with the scapula and 
clavicle in order to save the shoulder joint. A good plan 
is to stand behind the patient and grasp the scapula with 
one hand, so that the fingers prevent its upward movement 
and the thumb its outward movement. The other hand 
grasps the elbow or some other convenient part of the 
upper limb. The movements vary with the conditions to be 
treated and the surgeon should be consulted in all cases of 
fracture and dislocation. It is a good plan to begin by carry¬ 
ing the arm forward (flexion) and backwards (extension) 
without moving the arm outwards (abduction). Next a cir¬ 
cular movement of the elbow may be introduced, to produce 
circumduction; and finally abduction should be attempted. 

Hip Joint.—This is also difficult to manipulate; on ac¬ 
count of the weight of the lower limb, the flexibility of the 
trunk, and furthermore the patient often moves the pelvis 
on the spine or alters the shape of the spine to save the hip. 
The patient should be placed in the recumbent attitude. In 
doing extension {i.e., straightening of the thigh at the hip) 
notice whether the patient hollows the back during the move¬ 
ment, and if so placing the other hip in flexion, with the knee 


MASSAGE 


bent, and retaining it there by some means, will assist in ob¬ 
taining a more complete extension. Remember that this treat¬ 
ment is only for obstinate stiff joints. Simple flexion exten¬ 
sion, adduction, and abduction may be performed at the hip. 
The patient’s lower limb is grasped by the nurse and the thigh 
made to move upwards towards the trunk (flexion), down¬ 
wards into line with the body (extension), outwards (abduc¬ 
tion), inwards (adduction) and circularly (circumduction). 

Knee.—In a knee joint there are two movements, namely 
flexion and extension. The patient should be placed in the 
recumbent attitude and the nurse, grasping the leg, alter¬ 
nately bends and straightens the knee. 

Ankle.—In moving the ankle joint a much greater excur¬ 
sion is obtained by having the knee bent. With a stiff ankle 
begin in this position, but, as improvement takes place, gradu¬ 
ally straighten the knee until finally all movements are done 
with the knee straight. The movements at the ankle joint 
are extension, in which the foot is straightened on the leg, 
and flexion, in which the foot is bent at the ankle. 

Foot Joints.—Inversion and adduction, eversion and abduc¬ 
tion, and circumduction may be performed by grasping the an¬ 
terior part of the foot with one hand, the lower part of the 
leg with the other, and moving the foot inwards, at the same 
time twisting it inwards; outwards and twisting outwards; 
and performing a circular movement at the toes respectively. 

Active Movements of the Various Joints 

In surgical nursing active movements are employed in the 
treatment of paresis from various causes. The nurse should 
begin by ascertaining which of the patient’s movements are 
below normal strength and the degree of weakness present. 
This is important because a weak muscle should not be 
subjected to excessive work either in the kind, or duration 
of the exercise given. It is generally advisable to begin 
with very easy movements, which should be performed five 
or six times each. Minimum movements are generally most 
serviceable in commencing treatment; and should be followed 
by resistance exercises or free movements, according to choice 


MASSAGE 

and circumstances. The following shows briefly the difficulties 
encountered in movements of the various joints. 

Hand and Fingers. —Deficiency of movement in the fingers 
is best treated by exercising the fingers, joint by joint; begin 
with the terminal phalanx, then introduce the second and 
finally the third joint. The nurse should maintain the pa¬ 
tient’s wrist and hand in a straight line while the finger 
movements are being practised. Straightening of the fingers 
is sometimes assisted by bending the wrist forwards. After 
flexion of the fingers has been restored, the hand being still 
weak, the wrist should be bent backwards during closure of 
the hand and the patient made to exercise in this position. 

Wrist.—Weakness of the wrist movements may be treated 
by bending and straightening the hand on the forearm, the 
thumb being held uppermost. As the muscles recover the 
difficulty of the bending movement may be increased by in¬ 
creasing the supination of the forearm, and of the straighten¬ 
ing movement by increasing the pronation. 

Forearm.— For twisting movements of the forearm (pro¬ 
nation and supination) it will be found advantageous to bend 
the patient’s elbow and have the forearm held in a perpen¬ 
dicular position with the hand uppermost. 

Elbow.—In exercising the muscles moving the elbow joint 
the whole arm should be abducted and supported on a hori¬ 
zontal surface covered with cardboard, or the arm may be 
held so that the external ligaments carry the weight. 

Shoulder.—The greatest difficulty is usually experienced 
with abduction ( i.e ., removing the arm outwards). If the 
shoulder is very weak, place the patient in the recumbent 
position with a piece of cardboard beneath the upper limb 
and shoulder. The patient then moves the upper limb out¬ 
wards over the cardboard. The movement is more easily 
performed if the elbow is bent. As recovery takes place the 
patient is able to do this exercise in a sitting position, and 
then abduction with the elbow bent should precede abduction 
with the elbow extended. 

Movements of the Spine. — (a) Flexion (bending the body 
forwards). When this movement is deficient, place the pa- 


MASTITIS 


tient in the sitting position with a support for the back. 
The difficulty is increased by gradually lowering the sup¬ 
port until the patient is able to rise to a sitting position 
from the recumbent attitude. (b) In extension (backward 
bending) the patient begins in a position of slight flexion 
with the elbows and chest supported by pillows. The move¬ 
ment consists in straightening the back from the bent po¬ 
sition, and the severity of the exercise is gradually increased 
by removing the pillows. 

Hip .—In paresis of the hip the patient is placed in a re¬ 
cumbent attitude and the various exercises can then be per¬ 
formed by placing the limb on a cardboard or similar sur¬ 
face. Flexion consists in drawing the limb upwards towards 
the trunk; abduction in moving the limb outwards; adduction 
in moving the limb inwards. To obtain a backward move¬ 
ment at the hip (extension) the patient should be placed on 
his side with the limb to be treated uppermost and a thin 
sheet of wood covered with cardboard should be placed be¬ 
tween the limbs. 

Knee.—Place the patient on his side so that the lateral 
ligament supports the weight of the leg and proceed by mak¬ 
ing the patient bend and straighten the knee. 

Ankle and Foot.—Place the patient face downwards with 
the knee bent and the leg held perpendicularly with the foot 
uppermost. Flexion and extension at the ankle joint, inver¬ 
sion and eversion at the mid-tarsal joint may then be per¬ 
formed. Winding twine round the toes and holding the ends 
to apply resistance, sometimes assists in giving direction and 
precision to the patient’s movements. 

MASTITIS 

Acute Mastitis.—Acute inflammations of the breast, known 
as acute mastitis, usually occur in women during the close 
of the lactating period. It is the result of improper hygiene 
of the nipples, although this may not always be the case. 

Symptoms.—The patient may complain of pain and heavy 
feeling in the breast, and, at the same time, redness, swelling, 


MASTITIS 

and areas of hardness may appear in certain parts of the 
breast. There are a rise in temperature, an increase in the 
pulse rate, loss of appetite, slight headache, and a feeling 
of general malaise. 

Treatment.—If pus has not yet formed, the breast is 
elevated with the bandage in such a way that it is firmly 
supported upward. This will do much to relieve the pain, 
but care should be taken that the binder is not applied too 
tightly. Nursing, as a rule, is discontinued, and if the 
breast throbs and feels distended, the milk may be expressed 
regularly either by gentle massage, the direction of the 
massage being a stroking motion from the circumference of 
the breast towards the nipple, or the milk may be aspirated 
by a breast pump. During the interval, either hot applica¬ 
tions such as flaxseed poultices, may be applied to the breast, 
or cold applications in the form of a magnesium sulphate 
solution of 50 per cent, strength. When pus is formed the 
abscess is opened by the surgeon and freely drained. After 
the acute suppurative process has subsided the drainage 
tubes are shortened gradually and the granulation tissue 
stimulated by silver nitrate. 

Chronic Mastitis.—This condition is not uncommon, and 
presumably is due to a chronic inflammation of the breast. 
The patient complains of vague and indefinite pains localized 
in the breast itself, and, on examination, there may be found 
here and there some very small nodules which may be 
tender. At times the lymph glands in the axilla (arm-pit) 
show enlargement; as a matter of fact this condition is 
frequently difficult to distinguish from cancer of the 
breast. 

Treatment.—Sometimes a well-fitting breast binder will 
relieve much of the pain. If there is considerable induration 
or hardness of the tissue, warm fomentations may bring 
relief. If these measures fail, most surgeons will remove 
that portion of the breast which is pathological. If at the 
time of operation it is thought that the condition might be 
cancerous, the entire breast and deeper tissues are re¬ 
moved. 


MEDICINES, ADMINISTRATION OF 
MASTOIDS 

See Ear Nursing. 

MASTOIDITIS 

See Brain Abscess. 

MATZOON 

Matzoon, or kefir kumyss, is made by fermenting milk 
with a kefir fungus, a fungus obtained from Caucasia in 
Russia. It is also known as zoolak. 

MEASLES, NURSING IN 

Isolate. Use precautions as in scarlet fever. Keep room 
dark. Cleanse eyes with boric acid solution 2 per cent. 
Doctor may order argyrol (18 per cent.) dropped in eyes. 
Patient not to become chilled. Omit bed and tub baths 
until temperature has been normal two or three days and 
all rash disappeared. 

Complications. —Croup, pneumonia, diphtheria, otitis media 
and enlargement of the cervical glands. Watch the charac¬ 
ter of the stools, especially with small children. 

Diet. —Liquids until temperature is normal; then soft 
and regular diet. If there is no discharge from nose or 
throat disease is not thought communicable after rash disap¬ 
pears. 

(See Infectious Diseases, Course of.) 

MEASURES 

See Weights and Measures. 

MEDIASTINUM 

See Lungs. 

MEDICINES, ADMINISTRATION OF 

Accuracy 

While preparing medicines the nurse should concentrate 
her entire attention upon the work. She should not be dis¬ 
turbed by other duties. 

1. When calculating doses be sure your answer is correct; 
verify it if in doubt. 

2. Familiarize yourself with the smallest and largest doses 
of the remedies you are giving. If you think the maximum 
dose has been exceeded always verify it. 

3. Always look three times at the label of every bottle or 
box before using any of its contents: when taking it from 
the closet, when removing the contents, and when returning 
the bottle or box to the medicine closet. 


MASSAGE 


all seem to strike simultaneously. Percussion may also be 
of a hacking movement, carried out by striking the part with 
the ulnar border of the hand. Both hands are used alter¬ 
nately and the movements follow one another rapidly. 

5. Vibration. —This is a procedure applied to special parts 
and consists in applying the whole hand and making it 
tremble so as to produce a vibration in the patient’s body. 

Massage as a Therapeutic Agent. —Massage is used in the 
treatment of sprains, dislocations, fractures and other surgical 
affections. Abdominal massage may be used to improve 
digestion and alleviate constipation, while general massage 
may be used in conditions of general weakness. 

Sprains.—Recent sprains may be treated with light mas¬ 
sage to reduce the swelling and limit the effusion. It is 
advisable to use stroking movements (with the tips of the 
fingers) in commencing the treatment. As the tenderness 
disappears the manipulations may become more vigorous and 
passive and active movements should be added. 

Dislocation. —After reduction of a dislocation gentle mas¬ 
sage and movements tend to alleviate the pain and promote 
the absorption of the inflammatory products. Postpone more 
vigorous manipulations until the torn ligaments have healed. 
In performing passive movements after a dislocation, it is 
quite sufficient to do one or two thorough movements. 

Fractures. —In recent fractures only the gentlest massage 
should be used for some days. Light touch and stroking 
movements have a remarkable power of relieving the pain 
occasioned by the fracture. As healing takes place stroking, 
superficial kneading, and gentle passive and active movements 
are introduced; and finally, when union is complete, vigorous 
manipulations and movements both active and passive are 
used to restore the functional activity of the part. It is not 
always necessary to remove the splints in commencing treat¬ 
ment by massage, as benefit may be derived from manipu¬ 
lating the exposed parts above and below the seat of fracture. 

Pott’s and Colles’ Fractures. —On account of the dis¬ 
ability and deformity following these fractures massage is 
usually employed from the beginning of treatment. Passive 
and active movements of the ankle and toes in Pott’s frac¬ 
ture, and of the fingers and wrist in Colles’ fracture, should 
be used early to ensure a good result. Touch, stroking and 
superficial kneading are the procedures most suitable for the 
immediate treatment. 


MOVEMENTS 

Movements in surgical nursing may be passive or active— 
Passive movements are performed by the nurse on the 
patient’s passive body; in these, joints are moved and liga- 


MASSAGE 


ments, tendons, and tissues are stretched. Passive movements 
are more or less mechanical in their action, though in some 
cases, as in a recent fracture, they may be employed to 
bring about gentle exercise of the muscles as well. 

•Active movements are those in which the patient’s volition 
is called upon to bring about contractions of the muscles 
of the body and so to perform movements of various kinds. 

Active movements may be divided into— 

Free movements. —These are carried out voluntarily by 
the patient, without assistance or resistance. 

Resistive movements. —In these the patient’s movements 
are opposed by the nurse; and they may be concentric or 
eccentric. In the concentric form, the patient commences 
with the muscles to be exercised in a position of relaxation 
and contracts them against the resistance of the nurse. In 
the eccentric form, the patient begins with the muscles al¬ 
ready contracted and endeavours to maintain the contrac¬ 
tion which the nurse relaxes. As for example, the muscles 
on the anterior aspect of the upper arm bend the elbow so 
that the hand moves towards the shoulder. If the patient 
bends the elbow while the nurse resists, the movement is 
concentric; but if the elbow is bent and the nurse straightens 
it against the patient’s resistance, the movement is eccentric. 

Minimum movements. —In surgical nursing, cases of pare¬ 
sis occur in which the patient is able to perform neither 
ordinary active movements nor exercises against the least 
resistance; but he may be able to bring about a small con¬ 
traction of a muscle group under suitable conditions. These 
conditions are: a reduction to a minimum of the forces and 
factors which tend to interfere with the movements of the 
muscles. Friction, gravity and mechanical interference with 
the line of action of a muscle may be mentioned as examples. 
Friction may be reduced by using a large sheet of smooth 
cardboard placed on an even surface and covered with ordi¬ 
nary boracic powder. A patient with paresis of the hip 
muscles, for example, is put in the recumbent attitude with 
the lower limb supported on cardboard. 

For flexion, the patient draws the heel upwards towards 
the trunk; for abduction and adduction, the limb is extended 
and the patient glides it over the smooth surface of the card¬ 
board. The action of gravity is minimized by supporting the 
part to be exercised on a horizontal surface, or by using 
the ligaments of joints to support the weight of the distal 
part of the limb. In paresis of the wrist, for example, ordi¬ 
nary bending and straightening may be impossible; but turn 
the hand so that the thumb is uppermost and the weight is 
supported by the lateral ligament and movement may be 
appreciable. As the muscles gain in strength the difficulty 


MASSAGE 


of this movement may be increased by turning the thumb 
outwards for flexion ( i.e., bending) and inwards for exten¬ 
sion ( i.e., straightening the wrist). An example of dealing 
with the mechanical interference to the line of action of a 
muscle will be given under Active Movements of the Hand. 


Passive Movements of the Various Joints 

Fingers.—The nurse, grasping the patient’s hand in her 
left hand, alternately bends and straightens each finger. 
Each joint of each finger is similarly treated and in addition 
a circular movement of the whole finger on the hand may 
be performed. In all passive movements the severity of the 
treatment varies with the indications and the nurse should 
obtain explicit instructions from the surgeon. 

Wrist.—Grasp the patient’s wrist with the left hand and 
carry out bending, straightening and lateral movements. 

Forearm. —Grasp the patient’s elbow with one hand and 
obtain a handshake grasp with the other. The patient’s hand 
is then twisted alternately outwards and inwards. A firmer 
grasp is obtained by extending the fingers upwards on the 
patient’s wrist. The movements should be executed slowly 
and deliberately. 

Elbow. —Grasp the patient’s upper arm with one hand and 
the forearm with the other—bend and straighten alternately. 

Shoulder. —This is a difficult joint to manipulate, as the 
patient usually performs movements with the scapula and 
clavicle in order to save the shoulder joint. A good plan 
is to stand behind the patient and grasp the scapula with 
one hand, so that the fingers prevent its upward movement 
and the thumb its outward movement. The other hand 
grasps the elbow or some other convenient part of the 
upper limb. The movements vary with the conditions to be 
treated and the surgeon should be consulted in all cases of 
fracture and dislocation. It is a good plan to begin by carry¬ 
ing the arm forward (flexion) and backwards (extension) 
without moving the arm outwards (abduction). Next a cir¬ 
cular movement of the elbow may be introduced, to produce 
circumduction; and finally abduction should be attempted. 

Hip Joint.—This is also difficult to manipulate; on ac¬ 
count of the weight of the lower limb, the flexibility of the 
trunk, and furthermore the patient often moves the pelvis 
on the spine or alters the shape of the spine to save the hip. 
The patient should be placed in the recumbent attitude. In 
doing extension (i.e., straightening of the thigh at the hip) 
notice whether the patient hollows the back during the move¬ 
ment, and if so placing the other hip in flexion, with the knee 


MASSAGE 


bent, and retaining it there by some means, will assist in ob¬ 
taining a more complete extension. Remember that this treat¬ 
ment is only for obstinate stiff joints. Simple flexion exten¬ 
sion, adduction, and abduction may be performed at the hip. 
The patient’s lower limb is grasped by the nurse and the thigh 
made to move upwards towards the trunk (flexion), down¬ 
wards into line with the body (extension), outwards (abduc¬ 
tion), inwards (adduction) and circularly (circumduction). 

Knee. —In a knee joint there are two movements, namely 
flexion and extension. The patient should be placed in the 
recumbent attitude and the nurse, grasping the leg, alter¬ 
nately bends and straightens the knee. 

Ankle. —In moving the ankle joint a much greater excur¬ 
sion is obtained by having the knee bent. With a stiff ankle 
begin in this position, but, as improvement takes place, gradu¬ 
ally straighten the knee until finally all movements are done 
with the knee straight. The movements at the ankle joint 
are extension, in which the foot is straightened on the leg, 
and flexion, in which the foot is bent at the ankle. 

Foot Joints. —Inversion and adduction, eversion and abduc¬ 
tion, and circumduction may be performed by grasping the an¬ 
terior part of the foot with one hand, the lower part of the 
leg with the other, and moving the foot inwards, at the same 
time twisting it inwards; outwards and twisting outwards; 
and performing a circular movement at the toes respectively. 

Active Movements of the Various Joints 

In surgical nursing active movements are employed in the 
treatment of paresis from various causes. The nurse should 
begin by ascertaining which of the patient’s movements are 
below normal strength and the degree of weakness present. 
This is important because a weak muscle should not be 
subjected to excessive work either in the kind, or duration 
of the exercise given. It is generally advisable to begin 
with very easy movements, which should be performed five 
or six times each. Minimum movements are generally most 
serviceable in commencing treatment; and should be followed 
by resistance exercises or free movements, according to choice 


MASSAGE 

and circumstances. The following shows briefly the difficulties 
encountered in movements of the various joints. 

Hand and Fingers.—Deficiency of movement in the fingers 
is best treated by exercising the fingers, joint by joint; begin 
with the terminal phalanx, then introduce the second and 
finally the third joint. The nurse should maintain the pa¬ 
tient’s wrist and hand in a straight line while the finger 
movements are being practised. Straightening of the fingers 
is sometimes assisted by bending the wrist forwards. After 
flexion of the fingers has been restored, the hand being still 
weak, the wrist should be bent backwards during closure of 
the hand and the patient made to exercise in this position. 

Wrist.—Weakness of the wrist movements may be treated 
by bending and straightening the hand on the forearm, the 
thumb being held uppermost. As the muscles recover the 
difficulty of the bending movement may be increased by in¬ 
creasing the supination of the forearm, and of the straighten¬ 
ing movement by increasing the pronation. 

Forearm. —For twisting movements of the forearm (pro¬ 
nation and supination) it will be found advantageous to bend 
the patient’s elbow and have the forearm held in a perpen¬ 
dicular position with the hand uppermost. 

Elbow. —In exercising the muscles moving the elbow joint 
the whole arm should be abducted and supported on a hori¬ 
zontal surface covered with cardboard, or the arm may be 
held so that the external ligaments carry the weight. 

Shoulder.—The greatest difficulty is usually experienced 
with abduction ( i.e removing the arm outwards). If the 
shoulder is very weak, place the patient in the recumbent 
position with a piece of cardboard beneath the upper limb 
and shoulder. The patient then moves the upper limb out¬ 
wards over the cardboard. The movement is more easily 
performed if the elbow is bent. As recovery takes place the 
patient is able to do this exercise in a sitting position, and 
then abduction with the elbow bent should precede abduction 
with the elbow extended. 

Movements of the Spine.—(a) Flexion (bending the body 
forwards). When this movement is deficient, place the pa- 


MASTITIS 


tient in the sitting position with a support for the back. 
The difficulty is increased by gradually lowering the sup¬ 
port until the patient is able to rise to a sitting position 
from the recumbent attitude. (b) In extension (backward 
bending) the patient begins in a position of slight flexion 
with the elbows and chest supported by pillows. The move¬ 
ment consists in straightening the back from the bent po¬ 
sition, and the severity of the exercise is gradually increased 
by removing the pillows. 

Hip .—In paresis of the hip the patient is placed in a re¬ 
cumbent attitude and the various exercises can then be per¬ 
formed by placing the limb on a cardboard or similar sur¬ 
face. Flexion consists in drawing the limb upwards towards 
the trunk; abduction in moving the limb outwards; adduction 
in moving the limb inwards. To obtain a backward move¬ 
ment at the hip (extension) the patient should be placed on 
his side with the limb to be treated uppermost and a thin 
sheet of wood covered with cardboard should be placed be¬ 
tween the limbs. 

Knee. —Place the patient on his side so that the lateral 
ligament supports the weight of the leg and proceed by mak¬ 
ing the patient bend and straighten the knee. 

Ankle and Foot. —Place the patient face downwards with 
the knee bent and the leg held perpendicularly with the foot 
uppermost. Flexion and extension at the ankle joint, inver¬ 
sion and eversion at the mid-tarsal joint may then be per¬ 
formed. Winding twine round the toes and holding the ends 
to apply resistance, sometimes assists in giving direction and 
precision to the patient’s movements. 

MASTITIS 

Acute Mastitis. —Acute inflammations of the breast, known 
as acute mastitis, usually occur in women during the close 
of the lactating period. It is the result of improper hygiene 
of the nipples, although this may not always be the case. 

Symptoms. —The patient may complain of pain and heavy 
feeling in the breast, and, at the same time, redness, swelling, 


MASTITIS 

and areas of hardness may appear in certain parts of the 
breast. There are a rise in temperature, an increase in the 
pulse rate, loss of appetite, slight headache, and a feeling 
of general malaise. 

Treatment.—If pus has not yet formed, the breast is 
elevated with the bandage in such a way that it is firmly 
supported upward. This will do much to relieve the pain, 
but care should be taken that the binder is not applied too 
tightly. Nursing, as a rule, is discontinued, and if the 
breast throbs and feels distended, the milk may be expressed 
regularly either by gentle massage, the direction of the 
massage being a stroking motion from the circumference of 
the breast towards the nipple, or the milk may be aspirated 
by a breast pump. During the interval, either hot applica¬ 
tions such as flaxseed poultices, may be applied to the breast, 
or cold applications in the form of a magnesium sulphate 
solution of 50 per cent, strength. When pus is formed the 
abscess is opened by the surgeon and freely drained. After 
the acute suppurative process has subsided the drainage 
tubes are shortened gradually and the granulation tissue 
stimulated by silver nitrate. 

Chronic Mastitis.—This condition is not uncommon, and 
presumably is due to a chronic inflammation of the breast. 
The patient complains of vague and indefinite pains localized 
in the breast itself, and, on examination, there may be found 
here and there some very small nodules which may be 
tender. At times the lymph glands in the axilla (arm-pit) 
show enlargement; as a matter of fact this condition is 
frequently difficult to distinguish from cancer of the 
breast. 

Treatment. —Sometimes a well-fitting breast binder will 
relieve much of the pain. If there is considerable induration 
or hardness of the tissue, warm fomentations may bring 
relief. If these measures fail, most surgeons will remove 
that portion of the breast which is pathological. If at the 
time of operation it is thought that the condition might be 
cancerous, the entire breast and deeper tissues are re¬ 
moved. 


MEDICINES, ADMINISTRATION OF 
MASTOIDS 

See Ear Nursing. 

MASTOIDITIS 

See Brain Abscess. 

MATZOON 

Matzoon, or kefir kumyss, is made by fermenting milk 
with a kefir fungus, a fungus obtained from Caucasia in 
Russia. It is also known as zoolak. 

MEASLES, NURSING IN 

Isolate. Use precautions as in scarlet fever. Keep room 
dark. Cleanse eyes with boric acid solution 2 per cent. 
Doctor may order argyrol (18 per cent.) dropped in eyes. 
Patient not to become chilled. Omit bed and tub baths 
until temperature has been normal two or three days and 
all rash disappeared. 

Complications. —Croup, pneumonia, diphtheria, otitis media 
and enlargement of the cervical glands. Watch the charac¬ 
ter of the stools, especially with small children. 

Diet. —Liquids until temperature is normal; then soft 
and regular diet. If there is no discharge from nose or 
throat disease is not thought communicable after rash disap¬ 
pears. 

(See Infectious Diseases, Course of.) 

MEASURES 

See Weights and Measures. 

MEDIASTINUM 

See Lungs. 

MEDICINES, ADMINISTRATION OF 
Accuracy 

While preparing medicines the nurse should concentrate 
her entire attention upon the work. She should not be dis¬ 
turbed by other duties. 

1. When calculating doses be sure your answer is correct; 
verify it if in doubt. 

2. Familiarize yourself with the smallest and largest doses 
of the remedies you are giving. If you think the maximum 
dose has been exceeded always verify it. 

3. Always look three times at the label of every bottle or 
box before using any of its contents: when taking it from 
the closet, when removing the contents, and when returning 
the bottle or box to the medicine closet. 


MEDICINES, ADMINISTRATION OF 

4. Never use medicines from an unmarked bottle, or when 
you are in doubt as to the nature of the contents. 

5. When pouring fluids, hold the bottle with the label 
pointing upwards so as to avoid soiling it. 

6. Measure the quantities as ordered; do ‘not give a 
teaspoonful when a dram is ordered and vice versa. Measure 
the quantities with graduated measuring glasses or marked 
glass spoons. Do not use household utensils unless the 
others are not available. 

7. When measuring fluids hold the graduates so that the 
surface of the fluid, which is usually curved, is on a level 
with the eye. The quantity is read when the lowest part 
of this curve is on a line with the mark of the desired 
quantity, thus: 



8. Never pour a medicine back into the bottle. 

9. A medicine which forms a precipitate with another 

substance should always be given alone. Such medicines are 
said to be incompatible 

10. Give all medicines at times ordered; b. i. d. medicines 

should be given at 8 a. m. and 6 p. m., t. i. d. medicines 

should be given at 8 a. m., 12 m. and 6 p. m. 

11. Always stand at the patient’s bedside until, the medicine 
is taken. 

12. Never allow one patient to administer medicines to 

another. 

Time of Administration 

The time to administer most remedies is not as important 
as patients frequently imagine. For certain effects, however, 
certain times of administration are preferable to others. 

Remedies should be given before meals for the following 
effects: 

1. To aid the appetite or to increase the secretion of 
digestive juices. 

2. For a local effect on the stomach or intestines. When 
the substances are irritating they should be given in milk. 

Remedies should be given after meals, for the following 
effects: 

1. To neutralize digestive juices when these are present 
in excess. 

2. To aid absorption and produce rapid effects. 

3. Remedies which are given for absorption, but which 
are irritating to the tissues. 

Cathartics should be given between meals on an empty 








MELANCHOLIA, INVOLUTION 

stomach. Those acting slowly should be given at night. 
Those acting quickly should be given in the morning. 

Buies for Administration by Mouth 

x. For a rapid, general effect give the substance diluted in 
a large quantity of water immediately after meals, thus 
aiding absorption. 

2. For a slow, gradual, general effect give substances in 
small quantities of syrup, milk or wine between meals, to 
retard absorption. 

3. For a local effect on the stomach or intestines give 
the substance in acacia or mineral oil, thus lessening absorp¬ 
tion. 

4. Time as indicated above. 

Protection of Mouth and Teeth 

Remedies which are injurious to the teeth, such as iron 
or acids, should be given through a glass tube or straw. 

Administration to Children 

To children medicines should always be given in fluid 
form. Special care should be taken to thoroughly disguise 
substances having an unpleasant taste. Pills, tablets or 
capsules should not be given to children as they are apt 
to chew these preparations before swallowing them. 

Administration to Unconscious or Insane Patients 

Unconscious or insane patients who are unwilling to take 
medicines should be given substances only in fluid form. The 
medicines should be dropped on the back of the tongue with 
a small spoon. To insane patients it is frequently necessary 
to administer medicine through a narrow stomach tube 
passed through the nose. 

MELANCHOLIA, INVOLUTION 

This is a form of mental disease which occurs after 
middle life, characterized by an anxious depression, develop¬ 
ing slowly and pursuing a prolonged course. 

Physical symptoms.—Insomnia, loss of appetite, loss of 
weight, palpitation and dyspnea, with feelings of distress 
or discomfort in the chest and about the heart. 

Mental symptoms.—The patient is irritable, anxious, fear¬ 
ful, often very sad; has delusions of persecution, misfortune 
and self-accusation, of some sin committed many years 
before for which punishment must be endured; and may 
have hypochondriacal ideas. Orientation is not disturbed; 
memory is not much impaired, but there may be some retarda¬ 
tion of thought. Hallucinations of sight and hearing may 
be present. In conduct the patient is restless, agitated, moves 
about uneasily, picks and rubs the face, pulls the ears. 


MENOPAUSE 


bites the nails and knuckles, repeats over and over such 
phrases as “Save me,” or “Let me go home,” etc.; or, the 
patient may be mute and inactive, overwhelmed with de¬ 
spondency and have suicidal tendencies. 

Nursing procedures.—Rest in bed with liberal diet sup¬ 
plemented by special nourishment is usually prescribed. Food 
is often refused because of the delusions. Regularity in 
bathing and elimination should be established. When the 
patient is fearful and apprehensive and seems stubborn 
and resistive, explanation of what is about to happen or to be 
done will help to allay the fear and afford relief and com¬ 
fort for a little while. Avoid pulling, pushing or forcing 
the patient, and by persuasion accomplish what is desired 
even though a good deal of time is consumed. If persuasion 
fails, the attention should be diverted and results obtained 
by other methods. It may be necessary to bandage the hands 
if the patient picks much at the face, but it is far better 
to employ them by some form of light work. ' It should be 
remembered that the agitated, restless movements are largely 
reflex, and are the outward expression of the painful thoughts 
and feelings. These activities should be controlled by occu¬ 
pation, for any work which may be done by the hands 
makes demands on attention which will, for the time at 
least, crowd out the disturbing thoughts. Watchfulness is 
necessary at all times to prevent self-injury and destruction. 
Other nursing procedures are much the same as in the depres¬ 
sive psychoses. 

MENOPAUSE 

See Menstruation. 

MENORRHAGIA 

See Menstruation. 

MENSTRUATION 

Menstruation is the term applied to the series of changes 
characterized by a discharge of blood and mucus from the 
uterus, which recurs in woman from puberty to the meno¬ 
pause at regular intervals of about a month, except during 
pregnancy and lactation. Synonymous terms are the menses, 
the catamenia, or the monthly periods; and there are many 
euphemisms employed, such as “being unwell,” etc. 

The time at which menstruation first starts is generally 
the signal that the girl has become, physiologically speaking, 
a woman, capable of conception and childbirth. It therefore 
corresponds to what is more often called puberty. The actual 
age at which it occurs varies in different individuals, in 
different races, and in different parts of the world. In 
this country the great majority of girls begin to menstruate 


MENSTRUATION 


between the ages of 13 and 17, the average being 14 %. 
Differences of race and climate account for some differences, 
although perhaps not to the extent formerly believed. Social 
conditions have probably more effect upon the time of the 
onset. Rich food, luxury, and early mental stimulation 
bring it on early in the better classes. Dwellers in towns 
and cities start sooner than country girls. 

The onset of puberty is accompanied by a number of 
other changes both bodily and mental. These are the 
growth of the pelvis and its assumption of the adult female 
shape; the development of the external genitals; the appear¬ 
ance of hair on the pubes and in the axillae; the development 
of the breasts; and a general development of a graceful, 
rounded contour. Mentally the changes are in the direction 
of an increasing reserve, and the awakening of the sexual 
sense. These changes come on gradually, and the body 
does not become that of a fully developed woman until the 
age of about 20. This latter age is known as that of 
nubility —the earliest age at which pregnancy and childbirth 
can safely take place. 

Clinically the start of menstruation may be quite sudden, 
or may be preceded for several months by periodic head¬ 
aches and general upsets of health, without any actual 
discharge of blood. 

The Menopause is the time when menstruation ceases to 
recur. It is often spoken of as the “climacteric,” or the 
“change of life.” It usually occurs between 40 and 50, 
and rather oftener after 45 than before it. Before 40 and 
after 50 are quite unusual, although by no means unknown. 
There is no definite relationship between the age of the 
onset and the age of cessation of menstruation. As often 
as not an early start means a late menopause, and a late 
start an early cessation. The menopause is usually asso¬ 
ciated with other changes presumably due to the withdrawal 
of the ovarian internal secretion, as well as the stoppage 
of the monthly periods. There may be nervous, digestive, 
circulatory, and even mental symptoms. The cessation of 
menstruation may come on abruptly, or slowly. Frequently 
there is a certain amount of irregularity before it stops 
altogether. After the menopause has become established 
the sexual organs undergo retrogressive changes. The 
internal generative organs atrophy, and the breasts shrivel. 
Excess of fat is frequently deposited, or masculine charac¬ 
teristics may appear, such as the growth of hair on the face. 

Clinically it is a time requiring close watching. Scrupu¬ 
lous attention should be paid to general hygiene, and any 
symptoms treated as they occur. Particular care should be 
taken to investigate cases in which hemorrhage returns after 


MENSTRUATION 


a definite absence of some months at this time. Such cases 
are frequently cases of early cancer of the uterus, and, if 
recognized at once, may be treated by operation with some 
considerable hope of permanent cure. 

Menstrual Type. —This term refers to the interval between 
one period and the next. Such intervals should always be 
counted from the beginning of one period to the beginning 
of the next. The commonest type (75 per cent.) is the 
twenty-eight day type, the whole cycle of changes occurring 
regularly every twenty-eight days. In other cases the 
interval is thirty days, in others only twenty-one. Usually, 
however, in a healthy woman the same type is adhered to 
throughout, and as long as it is regular it is generally 
perfectly consonant with good health. Irregularity usually 
indicates some pathological condition. 

Menstrual Habit. —This term refers to the duration of 
menstruation, and indirectly to the amount of loss. The 
average duration is five days, but it varies greatly in dif¬ 
ferent persons. The extremes are cases where it only lasts 
an hour or two, and cases where it goes on for eight or 
ten days. Anything below two and above eight days is 
abnormal. The duration is affected by the same influences 
as affect the time of the first onset, being greater in hot 
climates, less in cold; greater in town dwellers, and in those 
living in luxury and eating stimulating food. Sexual stimu¬ 
lation and habits of thought tend to increase it—in short, 
“high living and low thinking.” 

Amenorrhea. —This means the absence of menstruation 
during the active sexual period of life from puberty to the 
menopause. Amenorrhea is one of- the early symptoms of 
pregnancy, and it occurs in 60 per cent, of women during 
lactation. 

Menorrhagia means excessive hemorrhage at the menstrual 
period. 

Metrorrhagia means bleeding from the uterus in the 
intervals between menstrual periods. 

Dysmenorrhea means painful menstruation. 

Leucorrhea means a discharge of a white or yellowish 
nature—not blood. 

Clinically menstruation is accompanied by symptoms of a 
general nature in the majority of women—the so-called 
menstrual molimina. There is frequently a feeling of heavi¬ 
ness and weariness. Dark lines appear under or around the 
eyes. The nervous system is more susceptible, and reflex 
irritability increased. The symptoms of other diseases tend 
to become exaggerated at the onset of menstruation. 

The temperature is said to be slightly lower during the 
period, and there is often a feeling of chilliness. The 


MENTAL DEFICIENCY 


excretion of urea is diminished and the blood pressure falls. 
There is also a diminution in the calcium content of the 
blood in the general circulation during the flow. 

From a purely clinical standpoint menstruation naturally 
divides itself up into the three periods of invasion, persistence, 
and decline. The period of invasion lasts only a few hours 
and is characterized by an increased flow of mucus as well 
as a feeling of heaviness and malaise. This is rapidly fol¬ 
lowed by the actual discharge of blood—the stage of per¬ 
sistence—which lasts for two to four days. Later the period 
of decline supervenes,- characterized by a gradual diminution 
in the flow of bright blood, and a return to a mucus flow 
as at the beginning. This last phase usually lasts only one 
or two days, the whole period gradually coming to an end. 

MENTAL DEFICIENCY 

This is a condition where from birth, or through accident 
or disease at an early age, there is a lack of normal develop¬ 
ment of the mind, in consequence of which the individual 
is incapable of performing his duties as a member of society 
in the position in which he is born. Feeblemindedness, 
as it is commonly called, is a permanent condition and can¬ 
not be cured, but a good deal can be done in many cases 
to improve, or, at any rate, make the most of what mentality 
there is. 

Certain physical deformities or “stigmata” are common 
in these conditions,—the shape of the skull, the shape and 
position of the ears, the shape of the palate, deformities of 
the nose, irregularities of the teeth, differences in the length 
of the arms and legs,. etc. 

“Binet-Simon Intelligence Tests,” are tests designed to 
show not only the degree of defect, but also which of 
the mental faculties are chiefly involved. 

Nurses in the industries, in schools and social service are 
more and more being called upon to make application of 
these tests in their work. A form of the tests is given 
but this work should only be undertaken after special training 
for it has been gained, preferably by instruction by a 
psychologist or other qualified teacher. 

BINET-SIMON TESTS FOR INTELLIGENCE AGE 
(Form arranged for the Johns Hopkins Dispensary.) 

Mentality of One and Two Years 

1. Eye follows light. 

2. Block placed in hand is grasped and handled. 

3. Suspended cylinder is grasped when seen. 

4. Candy is chosen instead of block. 


MENTAL DEFICIENCY 


5. Paper is removed from candy before eating, child 
having seen the wrapping. 

6. Child executes simple commands, and imitates simple 
movements. 


Mentality of Three Years 

7. Touches nose, eyes, mouth, and pictures of these as 
directed. 

8. Repeats easy sentences of six syllables, with no error. 

9. Repeats two numerals. 

10. Enumerates familiar objects in pictures. 

11. Gives family name. 

Mentality of Four Years 

12. Knows own sex. 

13. Recognizes key, knife, penny. 

14. Repeats three numerals in order, when heard once. 

15. Tells which is longer of lines differing by a centi¬ 
meter. 


Mentality of Five Years 

16. Discriminates weights of 3 and 12 grams, 6 and 15 
grams. 

17. Draws, after copy, a square that can be recognized as 
such. 

18. Repeats “His name is John. He is a very good boy,” 
and similar sentences. 

19. Counts four pennies. 

20. Rearranges a rectangular card that has been cut 
diagonally into two triangles. 

Mentality of Six Years 

21. Knows whether it is forenoon or afternoon. 

22. Defines, in terms of use, the words fork, table, chair, 
horse, mamma, three satisfactorily. 

23. Performs three commissions given simultaneously. 

24. Shows right hand, left ear. 

25. Distinguishes pretty from distinctly ugly or deformed 
faces, in pictures. 


Mentality of Seven Years 

26. Counts 13 pennies. 

27. Describes pictures shown previously in No. 10. 

28. Notes omission of eyes, nose, mouth, or arms, from 
as many portraits, three of the four. 

29. Draws diamond shape, from copy, so that it can be 
recognized. 

30. Names red, green, blue, yellow. 


MENTAL DEFICIENCY 


Mentality of Eight Years 

31. States difference between paper and cloth, butterfly and 
fly, wood and glass, in two minutes, two satisfactorily. 

32. Counts from 20 to 1 in twenty seconds, with not more 
than one error. 

33. Names days of the week in order, in ten seconds. 

34. Counts values of six stamps, three ones and three 
twos, in less than fifteen seconds. 

35. Repeats five numerals in order, when pronounced 
once. 

Mentality of Nine Years 

36. Gives correct change from a quarter paid for an 
article costing four cents. 

37. Defines in terms superior to statements of use, in 
No. 22. 

38. Names the day, month, day of month, year, allowing 
error of three days either way on day of month. 

39. Names the months in order, allowing one omission or 
inversion, in fifteen seconds. 

40. Arranges, in order of weight, boxes of same size and 
appearance weighing 6, 9, 12, 15 and 18 grams, in three 
minutes. Two out of three trials. 

Mentality of Ten Years 

41. Names a penny, nickel, dime, quarter, half dollar, two, 
five and ten-dollar bills, in forty seconds. 

42. Copies design after ten seconds’ exposure. 

43. Repeats six numerals. 

44. Tells what one should do in various emergencies, and 
answers questions difficult of comprehension. 

45. Uses three given words in two sentences. 

Mentality of Eleven Years 

46. Detects nonsense in three out of five statements, in 
about two minutes. 

47. Uses three given words in one sentence. 

48. Gives at least sixty words in three minutes. 

49. Names three words that rhyme with way in one 
minute. 

50. Rearranges shuffled words of 8-word sentences, two 
out of three, with one minute for each. 

Mentality of Twelve Years 

51. Repeats seven numerals in order, when heard once. 

52. Defines charity, justice, goodness, two satisfactorily. 

53. Repeats, with no error, sentence of 23-26 syllables. 

54. Resists suggestion as to length of line. 


MENTAL DISEASES 


55. Infers correctly the fact indicated by circumstances 
given, in each of two trials. 

Mentality of Fifteen Years 

56. Interprets pictures shown in Nos. 10 and 27. 

57. Imagines clock-hands interchanged for hour 12.20 
and for hour 2.56, telling the time. 

58. Writes “caught a spy” in symbols after learning code, 
one error permitted. 

59. Writes correctly the opposite of seventeen out of 
twenty given words. 

Mentality of an Adult (“Over 15 Years”) 

60. Imagines and draws results of cutting triangle from 
side of twice folded paper. 

61. Imagines and draws new form produced by joining 
the transposed pieces of diagonally divided rectangular card. 

62. Distinguishes between abstract terms of similar sound 
and meaning (evolution—revolution, event—prevent, etc.). 

63. Gives three differences between the president of a 
republic and a king. 

64. Gives the central thought of a selection read to him. 

MENTAL DISEASES, NURSING IN 

In every branch of medicine there has come the realiza¬ 
tion that the practice of nursing is an integral part of the 
practice of medicine, and a most important element of treat¬ 
ment. In no branch is this more true than in psychiatry, 
and coincidentally with the increase of interest and research 
in the treatment of disorders and diseases of the mind, 
has come a demand for nurses who are specially trained 
in the art and practice of nursing mental diseases. 

In the early days of the “asylum,” when the patient was 
deprived of his liberty by commitment for the protection of 
society and himself, very little scientific study leading to 
diagnosis, grouping or medical treatment was given, and 
the nurses’ duties were largely custodial. But to-day the best 
mental hospitals are laboratories of research where every 
known scientific measure may be applied and brought to 
the aid of the patient in order that he may be cured, if 
possible, or at least that his condition may be so improved 
that he may be returned to society. 

The application and carrying out of many of these meas¬ 
ures requires intelligent cooperation and skill on the part 
of the nursing staff. To ensure this end, many mental hos¬ 
pitals have established schools of nursing, maintaining 
affiliations with general and special hospitals for courses 
in subjects which they cannot adequately give; and others 


MENTAL DISEASES 


provide special courses in the nursing of nervous and 
mental diseases for nurses who have received previous train¬ 
ing in general hospitals. 

The course in mental nursing as prescribed by the best 
schools includes lecture courses and instruction in the sub¬ 
jects of psychology, psychiatry, psychotherapy, psychoanalysis, 
reeducation, occupation therapy, hydrotherapy, mechano¬ 
therapy, electrotherapy, massage and diversions. Frequent 
clinics and demonstrations of nursing procedures are also 
provided, and ample opportunity for the practical applica¬ 
tion of nursing measures is given under efficient direction and 
supervision. 

The importance of training in the field of mental nursing 
is constantly being more widely recognized and insisted upon 
as a part of the equipment of every nurse, and schools 
of nursing in general hospitals which have not the facilities 
for giving a course are providing it by affiliation with the 
best mental hospitals. Among the better known mental 
hospitals are: Butler Hospital, Providence, Rhode Island; 
McLean Hospital, Waverly, Massachusetts; Boston Psycho¬ 
pathic Hospital, Boston, Massachusetts; Bloomingdale Hos¬ 
pital, White Plains, New York; the Henry Phipps Psychiatric 
Clinic, Johns Hopkins Hospital, Baltimore, Maryland; Cook 
County Psychopathic Hospital, Chicago, Illinois; Iowa 
Psychopathic Hospital, Iowa City, Iowa; State Psychopathic 
Hospital, at the University of Michigan, Ann Arbor, Michi¬ 
gan; and Syracuse Psychopathic Hospital, Syracuse, New 
York. 

In increasing numbers general hospitals are establishing 
psychopathic departments as a part of the hospital unit. 
In these hospitals the course in nursing mental diseases is 
an integral part of the general training. Among these hos¬ 
pitals are: Letterman General Hospital, Presidio, San Fran¬ 
cisco, and the Los Angeles County Hospital, California; 
Walter Reed General Hospital, Washington, D. C.; Newark 
City Hospital, Newark, New Jersey; Bellevue Hospital, New 
York City; King’s County Hospital, Brooklyn; Albany Hos¬ 
pital, and Buffalo City Hospital, in New York State; Cin¬ 
cinnati General Hospital, and Cleveland City Hospital, in 
Ohio; Philadelphia General Hospital and St. Francis Hos¬ 
pital, Pittsburg, in Pennsylvania. 

The state hospitals are rapidly falling into line and are 
providing a better and more intelligent nursing service for 
the large numbers of patients for whom they care. Many 
of these hospitals have schools of nursing in which excellent 
standards are maintained. 

In the field of public health no more interesting or im¬ 
portant work presents itself to the well trained nurse than 


MENTHOL 


that of mental hygiene. The Smith College Training School 
for Social Work at Northampton, Massachusetts, offers a 
summer course in psychiatric social service with training 
centers in Boston, New York, Cincinnati and Minneapolis; 
and the New York School of Social Work, 105 East 22nd 
Street, New York City, offers a similar course to young 
women desirous of preparing themselves for this branch of 
nursing. 

MENTHOL 

Menthol is a camphor-like substance (stearoptene) ob¬ 
tained from the oil of peppermint. It produces a feeling 
of coolness on the skin and mucous membranes, and pro¬ 
duces local anesthesia. The anesthesia is not sufficiently 
marked, however, to enable a surgical operation to be per¬ 
formed. It is used principally to relieve painful conditions 
of the skin. 


MERCURIALISM 

See Mercury. 

MERCURY (HYDRARGYRUM) 

Mercury or quicksilver is a silver-colored liquid metal 
which evaporates very easily. Many of its salts are used 
in medicine. 

Appearance of the Patient 

A few hours after giving an average dose of a prepara¬ 
tion of mercury, the patient usually has several movements 
of the bowels and more urine is passed. The stools are soft, 
colored with bile, and accompanied by a little griping. 
Occasionally the flow of saliva is also slightly increased. 

If small doses of mercury preparations are given contin¬ 
uously for weeks or longer, to a patient suffering from the 
first or second stage of syphilis, the symptoms, such as 
the original ulcer or chancre, the rash on the body, the 
mucous patches in the mouth, and the swelling of the glands, 
all gradually disappear. 

Local action: Applied to the skin, mercury preparations 
are excellent antiseptics. If a strong solution is used, or even 
a weak solution continuously, redness, pain and itching 
of the skin will result. If a strong solution is kept in 
contact with the skin for a long time, inflammation and 
even destruction of the skin may result. 

Mucous membranes are shrunk and contracted by the 
action of mercury preparations (astringent action). 

Internal Action: In the mouth: Mercury preparations 
have a distinct metallic taste, and contract the mucous mem¬ 
brane. 


MERCURY 


In the stomach: They slightly increase the secretions, 
occasionally causing nausea. 

In the intestines: Mercury preparations increase the 

secretions and peristalsis, causing frequent soft stools 
stained with bile. They also act as intestinal antiseptics. 

Action after Absorption 

Mercury salts are readily absorbed into the blood from all 
the mucous membranes, from the lungs, and even by the 
skin. When given by mouth, they are absorbed in i to 2 
hours. After absorption, they affect principally the intes¬ 
tines, the kidneys, some of the secretions, the nutrition of 
the tissues, and if given steadily, they act as a specific for 
the first and second stages of syphilis. 

Action on the kidneys: Mercury salts increase the flow of 
urine. 

Action on the secretory glands: All the secretions, espe¬ 
cially the saliva and pancreatic juice, are increased. 

Action on nutrition: Small doses of mercury preparations, 
if given for some time, increase the nutrition of the tissues, 
and the body weight. 

Specific Action in Syphilis 

Syphilis is a chronic infectious disease, caused by the 
Spirochseta pallida, a spiral-shaped organism. The infection 
begins with the formation of a hard ulcer, or chancre, usually 
on the genital organs. This is known as the first stage of 
the disease. It is followed in about six weeks, by an erup¬ 
tion all over the body (roseola), whitish patches in the 
mouth (mucous patches), and swelling of all the lymph 
glands throughout the body. This is known as the second 
stage of the disease. Some time later, in several months 
or years, or at any time during the patient’s lifetime, he 
may suffer from various diseases, which result from the form¬ 
ation of gummata. Gummata are areas of round cells which 
readily decompose, forming a thick fluid in the center. 
Any organ of the body may be affected in this way, produc¬ 
ing many and varied symptoms. The occurrence of these 
late symptoms is known as the third stage of the disease. 

Parents infected with syphilis may transmit the disease 
to their children. The children may be born dead, or they 
may suffer, if they live, at any time during their childhood 
from various symptoms which are characteristic of the third 
stage of the disease in the acquired form. 

Effect of Mercury 

Mercury preparations, if given steadily to a patient suf¬ 
fering from the first or second stage of syphilis, usually 


MERCURY 


relieve all the symptoms in a very short time. The rash 

and the mucous patches soon disappear, the glands become 
smaller; until they, too, finally disappear. This curative 
action of mercury in syphilis is probably due to the destruc¬ 
tion of the spirochaeta pallida, the organism which causes the 
disease. 


Excretion 

Mercury preparations are excreted mainly by the kidneys 
and the intestines, and also slightly, by all the excretions, 
such as the saliva, milk, bile, gastric juice, etc. They are 
very slowly eliminated from the body, usually in one or two 
days. Some of the mercury often remains in the body for 
a long time afterwards, and may then be gradually excreted 
for some time. 


Acute Mercury Poisoning 

Acute mercury poisoning usually results from one of the 
mercury salts, such as the bichloride of mercury tablets, 
taken with suicidal intent. 

Symptoms. —i. Metallic taste in the mouth, and burning 
pain in the throat. 

2. Cramp-like, abdominal pains. 

3. Nausea and vomiting; the vomited matter contains bile 
and later blood. 

4. Diarrhea with bloody stools. 

5. Scanty urine which may contain blood. 

6. Collapse, as a result of the profuse vomiting and diar¬ 
rhea; rapid, weak, irregular pulse, the face is pinched and 
anxious, the skin is cold and moist, the breathing slow and 
shallow. 

7. Convulsions and coma may occur before death. 

Usually the patient lives several days or weeks; he develops 

a very severe acute nephritis characterized by scanty, bloody 
urine, which contains albumen. He finally develops uremia 
with convulsions, coma and death. 

Death from mercury poisoning usually occurs in from one 
to seven days. 

Treatment.—1. The antidote for mercury poisoning is 
white of egg, milk or flour. These substances contain 
albumens, which combine with the mercury, forming an 
albuminate of mercury, and thus prevent the poisonous 
effects. About one egg should be given for every 4 grains 
of bichloride of mercury or other preparation taken. 

2. Opium or morphine is given to check the diarrhea, and 
to keep the patient quiet. 

3. The collapse is treated with heart stimulants such as 
caffeine, atropine, strychnine, etc. 


MERCURY 


“Mercurialism” 

Mercurialism is a very common condition which results 
from prolonged use of mercury preparations. Syphilitic 
patients can often take large doses of mercury without 
developing any poisonous effects. 

Symptoms. —The following are the symptoms of excessive 
mercury action: 

1. Profuse flow of saliva, and a metallic taste in the 
mouth. This is soon followed by: 

2. Soreness and bleeding of the gums, later ulcerations 
of the gums, mouth or throat, loosening of the teeth, and 
even destruction of the jaw-bone. The breath has a very 
foul odor from the destroyed tissue. 

3. Diarrhea, often with bloody stools. 

4. Anemia. 

5. Loss of weight. 

6. Scanty urine. 

7. Paralysis of the hands or feet with “drop-wrists” or 
“drop-feet.” 

Treatment.—1. Stop the administration of mercury. 

2. The soreness of the gums is best relieved by a potas¬ 
sium chlorate mouth wash or a tannic acid mouth wash. The 
gums are often painted with tincture of myrrh. 

3. The diarrhea is best checked by opium. 

Uses 

Mercury preparations are used principally: 

1. As a specific for the first and second stages of syphilis. 

2. Many of the preparations are excellent antiseptics. 

3. Some of the preparations are excellent purgatives. 

4. Mercury is said to have a very beneficial effect in 
relieving acute infections of the serous membranes, such as 
pleurisy or peritonitis. It also reduces enlargements of 
lymph glands. 

Administration 

1. For absorption from the skin, mercury is applied by 
“rubbings” or inunctions in the form of an ointment. The 
ointment is thoroughly rubbed on the skin for six days, 
every day on a different region of the body; thus, one day 
on the arms, another day on the forearms, the thighs, the 
legs, the back, etc. On the seventh day the patient is 
given a bath to remove the ointment from the skin; and 
then the course is begun again. 

In giving mercury inunctions, the nurse should protect 
her hands with leather gloves, as otherwise she herself may 
absorb the drug, and develop poisonous effects. 

Mercury is also given for absorption by the skin, in the 


MERCURY 


form of vapor. The patient sits in a closed cabinet over a 
lamp containing burning calomel. The fumes thus gener¬ 
ated are absorbed by the skin. Some mercury preparations 
are frequently given by moutb. 

An excellent method of giving mercury is by deep injec¬ 
tions into the muscles. The preparation is usually injected 
into the muscles of the buttocks, which are then rubbed 
very thoroughly to hasten the absorption. 

Preparations 

Bichloride of Mercury, Corrosive Sublimate (Hydrargyri 
Chloridum Corrosivum) ; dose % o to Vio of a grain. 

This is rarely used internally. It is principally used as 
a local antiseptic in 1:1000 to 1:5000 solutions. It 
usually comes in tablets of 7V2 grains each, which are dis¬ 
solved in water to make up the required strength. Corrosive 
sublimate cannot be used to disinfect instruments, as it stains 
them black. 

Mild Mercurous Chloride, Calomel (Hydrargyri Chlori¬ 
dum Mite) ; dose Vio to 5 grains. 

This preparation is used principally as a cathartic. It is 
given in tablets or as a dry powder on the tongue. 

Blue Mass (Massa Hydrargyri) ; dose 2 to 8 grains. 

This is mercury rubbed with glycerin, honey, licorice, 
althea, etc., and contains 33% per cent, of mercury. It is 
used principally as a cathartic, in the form of pills; each pill 
containing 3 to 5 grains of blue mass. 

Mercury with Chalk, Gray Powder (Hydrargyrum cum 
Creta) ; dose 2 to 8 grains. 

This is a gray powder made like, blue mass, but it con¬ 
tains chalk in addition to the other ingredients. It is used 
as a mild cathartic. 

Yellow Iodide of Mercury, Protoiodide of Mercury 
(Hydrargyri Iodidum Flavum) ; dose % to 1 grain. 

Red Iodide of Mercury, Biniodide of Mercury (Hydrar¬ 
gyri Iodidum Rubrum) ; dose V&o to Vio of a grain. 

Solution of Arsenic and Mercuric Iodides (Liquor 
Arseni et Hydrargyri Iodidi) (Donovan’s Solution); dose 5 
to 20 minims. , 

This contains 1 per cent, each of arsenic iodide and the 
red mercuric iodide. 

Mercurial Ointment, Blue Ointment (Unguentum Hy¬ 
drargyri) . 

This is made by thoroughly rubbing together mercury, 
oleate of mercury, lard and suet. It is used principally for 
inunctions. 

Ointment of Yellow Mercuric Oxide (Unguentum Hy¬ 
drargyri Oxidi Flavi). 


METHYL SALICYLATE 


This contains io per cent of yellow oxide of mercury. 

Ointment of Red Mercuric Oxide (Unguentum Hy- 
drargyri Oxidi Flavi). 

This contains io per cent, of red oxide of mercury. 

Ointment of Red Mercuric Oxide (Unguentum Hy-- 
drargyri Ammoniati). 

This contains io per cent, of ammoniated mercury. 

Ointment of Mercuric Nitrate (Unguentum Hydrargyri 
Nitratis), Citrine Ointment. 

This contains 7 per cent, of mercuric nitrate. 

Black Wash (Lotio Hydrargyri Nigra). 

This consists of x dram of calomel to 1 pint of lime-water 
It is used as an external application. 

Yellow Wash (Lotio Hydrargyri Flava). 

This consists of half a dram of corrosive sublimate to 
1 pint of lime-water. It is used as a local application. 

Mercuric Salicylate (Hydrargyri Salicylas) ; dose % 0 to 

of a grain. 

This preparation is now frequently used, especially for 
intramuscular injections. For these injections, a 10 per cent, 
solution in water or liquid paraffin is used, of which xo 
minims is injected deep into the gluteal muscles every fourth 
day. 


MESOTHORIUM 

See Radium. 

METHYL SALICYLATE 

Methyl salicylate may be artificialy prepared from carbolic 
acid, or it may be obtained from the oil of gaultheria or 
wintergreen which is contained in the volatile oils of the 
birch and wintergreen. The oil is 96 per cent, methyl 
salicylate. 

Methyl salicylate is used as a counterirritant chiefly in 
acute and chronic articular rheumatism. 

Method of Application. —The oil may be painted over the 
part, or it may be placed on lint or on a compress which 
is wrapped around the joint. The application is then covered 
with oiled muslin to prevent evaporation. 

When the pain is not too acute, the oil may be rubbed 
on the part, in this way combining the stimulating effect 
of the rubbing with the irritating and stimulating effect of 
the oil. This increases its counterirritant effect and adds 
to the comfort of the patient. Of course, when this method 
is used, as the oil is volatile, some of its effects are lost. 
The diminished stiffness, the increased warmth and comfort 
which result, however, testify to the increased benefit due 
to the rubbing. 


METHYLENE BICHLORIDE 

After the application is made the part is covered with a 
compress or lint and oiled muslin (to prevent evaporation and 
loss of heat) and bandaged. Frequently the part is covered 
with flannel or bandaged with flannel bandages in order to 
mcrease the warmth and comfort. 

METHYLENE BICHLORIDE 

See Anesthetics. 

METHYLENE BLUE 

Methylene blue is a chemical substance which forms a 
deep blue solution in water. It is used principally as a 
urinary antiseptic in gonorrhea, and as a specific for 
malaria. It stains the urine a blue or dark green color. 
It is given in capsules, in doses of 2 to 8 grains. 

METRIC SYSTEM 

See Weights and Measures. 

METRORRHAGIA 

See Menstruation. 

MILK 

No food has so far been discovered which can be effec¬ 
tually substituted for milk. There is no food, however, 
which requires more attention in its selection and care. 
It is very susceptible to both odors and flavors, absorbing 
them both readily, as will be found if milk be placed in the 
same compartment with food's of strong odor and flavor, 
without being properly covered and protected. This is 
particularly noticeable with cucumbers, melons, etc. 

Milk also furnishes a splendid medium for bacterial 
growth, and if left exposed to the air, put into unclean 
receptacles, or kept in a warm place, will immediately become 
more or less contaminated, after which it is unwise to use 
it. Sterilization and pasteurization will in a measure over¬ 
come the bacterial contamination, but milk purchased from 
a dairy which is not clean or milked under unsanitary con¬ 
ditions will remain dirty, hence unfit for human consump¬ 
tion. When the morning’s milk supply is brought to the 
house it should be in clean, well-stoppered bottles, but 
before placing it in the icebox the tops of the bottles should 
be carefully wiped off with a wet cloth to remove any 
superficial dust which may be adhering to them. Every 
time a portion of the milk is removed thereafter the tops 
should be again cleansed before the milk is poured out. This 
is a wise precaution, and often prevents contamination from 
the hands, etc. 


MILK 


The amount of water in milk prevents its being an ade¬ 
quate food for adults except in certain pathological condi¬ 
tions. However, it furnishes a supplementary food 
unequaled by any other beverage known. There are fortu¬ 
nately only a few individuals who are unable to drink milk. 
There are many who fancy they cannot do so, but if the 
nurse has the ingenuity to utilize some of the various 
methods whereby milk is made more digestible, it will gen¬ 
erally be found that the patient can take it without trouble. 
In cases of personal dislike, if the milk is flavored or colored 
or made up into soup, cocoa, chocolate, junket, custards, 
blancmange, etc, it will usually prove acceptable. 4 

It must be understood that no matter what method is 
used to insure purity in milk, nothing does away with the 
necessity for keeping the milk both clean and cold. The 
receptacles in which the milk is allowed to stand, the vessels 
in which it is measured, and the person who handles it must 
be absolutely clean, and the nurse must keep in mind the 
fact that pasteurization does not completely destroy the 
bacterial growth in milk, that it merely diminishes it, and 
she must see that the milk which has undergone the pas¬ 
teurizing process is kept cold, otherwise the microorganisms 
which are present, even if to a less extent than in raw 
milk, will undoubtedly multiply. 

Adulteration of Milk. —There is not nearly so much 
adulteration of milk to-day as there was a few years ago. 
The stringent laws governing the care and composition of 
the milk make it unprofitable for the dairymen to practise it. 
However, there are times when such things are done and 
care must be taken to prevent it. Milk is, as has already 
been stated, very susceptible to contamination, and that 
which is infected with putrefactive bacteria is not fit for 
food even if the dealer has doctored it with formaldehyde. 
However, the danger to-day is not so much from drugs as 
from lack of care in the handling of the milk. It is well 
to remember, however, that water is an adulteration just the 
same as formaldehyde and perhaps more pernicious, since 
the quantities of the latter are so small in an ordinary 
quantity of milk as not to make a great deal of difference 
except in the feeding of invalids and children, while watered 
milk is a swindle not only to the pocketbook but to the 
body also, since the requisite nutritive value is lacking. 

Selection and Care of Milk. —There are a few essential 
facts to keep in mind in regard to milk: (i) Be sure of the 
source of the milk supply, especially in the feeding of the 
sick and of infants. Milk for such cases should always be 
purchased from inspected dairies when it is possible. 
(2) Keep the milk cold; the best milk in the world will 


MILK, METHOD OF PEPTONIZING 

spoil if left in a warm place. (3) Always keep the milk 
bottle well covered, thus eliminating the danger of con¬ 
tamination, flies, etc. 

Skimmed Milk. —Milk which has had the cream removed is 
still nutritious, but not so much so as whole milk. Babies 
fed upon skimmed milk will grow thin unless fat is added in 
some form. 

Buttermilk is milk which has been soured, either naturally, 
by allowing it to stand in a warm place until it is soured 
and coagulated, or, by adding lactic acid bacteria (Bulgarian 
Culture) to bring about the souring and coagulation. But¬ 
termilk may be made from whole or skimmed milk, but 
the latter is thin and watery and less palatable than that 
made from the milk with the cream left in. Buttermilk 
is one of the most wholesome forms in which milk can be 
taken, and for this reason is used largely in the invalid 
dietary and in the feeding of infants. Kumyss, Matzoon, 
and Zoolak are artificially fermented milk, and are used in 
the feeding of the sick. 

Whey.—Whey is an opalescent solution which remains 
after the coagulation of casein; it contains the greater part 
of the lactose, lactalbumen, and ash constituents of milk. 
Whey being fat-free is used as a substitute for part or 
all of the diluents in the modification of milk for infants 
under certain conditions specified by the physician. 

. MILK, METHOD OF PEPTONIZING 

Partially Peptonized Milk: To a bottle containing one 
pint of milk and 4 ounces of water, add one peptonizing 
powder. Keep the bottle at a temperature of 105° to 115° F. 
This is best done by placing the bottle in hot water of 
that temperature, for about 20 minutes to a half hour. The 
milk should then have a slightly bitter taste. Part of the 
proteins of the milk are digested by this method. 

Completely Peptonized Milk: The method for complete 
peptonization is the same as for partial peptonization, but 
it is continued for two hours, during which time all the 
proteins are completely digested. Completely peptonized 
milk has an extremely bitter taste. 

MINDERERUS, SPIRIT OF 

See Ammonium. 

MINERAL OIL 

See Liquid Petrolatum. 

MIOTICS 

Miotics are drugs which cause the pupil of the eye to 
contract, such as Pilocarpus and Eserine. 


MOSQUITOES 


MISCARRIAGE 

See Abortion. 

MIXTURES 

Mixtures are preparations consisting of several drugs 
mixed together. Fluids containing a substance which does 
not dissolve are also called mixtures. 

MONSELL’S SOLUTION 

See Iron. 

MORPHINE 

The effects of morphine differ slightly from those of opium 
in the following ways: 

1. Morphine is much more rapidly absorbed, and therefore 
acts more rapidly. 

2. It can be given hypodermically. 

3. It does not increase the secretion of sweat as much 
as opium. 

4. It is not as constipating as opium. (See Opium.) 

Preparations 

Morphine; dose % to 1/2 of a grain. 

Morphine Sulphate; dose % to Yz of a grain. 

Morphine Hydrochloride; dose % to V2 of a grain. 

Compound Morphine Powder (Tully’s powder); dose 5 to 
15 grains. 

This contains morphine sulphate, licorice powder, and 
camphor. 

MOSCHUS 

See Musk. 

MOSQUITOES 

Mosquitoes in the northern United States and Canada are 
more a nuisance than a danger, but where the malaria or 
yellow fever germs are found certain genera of mosquitoes 
are known to carry them to new human victims. These 
genera are, for malaria. Anopheles; and for yellow fever, 
Stegomyia. It is well to know the readily distinguishable 
physical characters of the former, at least, in all the four 
stages, egg, larva, pupa, adult. 

The contrasts with Culex, the ordinary genus, are quite, 
definite. Culex eggs occur up-ended, in rafts, looking much 
like a broad, flat, irregular bundle of very small cigars', 
floating so that each cigar is vertical. Anopheles eggs tend 
to float each one by itself horizontally, instead of in rafts 
and vertically. 

The larvae (“wigglers”) of the Culex at rest, like the 


MOSQUITOES 

Culex eggs, take a more or less vertical position, hanging from 
the surface of the water, head downward, their breathing 
tubes, which come from the tail end, thrust out to get the 
air. The Anopheles larvae breathe similarly but lie along the 
surface, horizontally. 

The differences between the pupae are pot so striking, but 
the adult Culex appears grayish, and humpbacked, while the 
Anopheles maculipennis appears black and carries its body 
in a straight line with its proboscis. Only the female “bites" 
in any genus; apparently blood is necessary to egg-laying. 
Both Anopheles and Stegomyia are harmless unless they 
become infected, the first with malaria by biting a patient 
in whom the malaria germs are circulating, the second by 
biting a patient in whom the (hypothetical) yellow fever germs 
are circulating. Both are harmless even then for 8 to 12 
days, during which the malaria germ is known to be, and 
the yellow fever germ is believed to be, undergoing various 
changes which end with the presence of the germ in the 
salivary glands of the mosquito. After this stage is reached, 
the disease germs may be transmitted in biting. So far, no 
other method of transmission (except direct transfer of 
blood from patient to prospective patient) is known for 
either disease. 

Two methods are employed for getting rid of these 
mosquito-borne diseases; one consists in preventing the 
mosquitoes from biting infected persons, thus keeping the 
mosquitoes uninfected, and therefore harmless; the other 
consists in preventing the breeding of mosquitoes and 
destroying those already in existence. 

Mosquitoes need water, protected water, in which to breed. 
Rain barrels, cisterns, quiet, shallow, fish-less pools, etc., 
are necessary. If wind or wave or bird or fish can reach 
the eggs, larvae or pupae, their chances are small of reaching 
the adult’s stage. Again, larvae and pupae must breathe while 
in the water, and by covering the water with a film of oil, 
they are prevented from reaching the air with their breath¬ 
ing tubes. 

To get rid of mosquitoes is much simpler than to get rid 
of flies. Drainage of swamps or pools, covering with oil 
such as cannot be drained away, placing fish in ornamental 
waters which it is wished to retain, at the same time clearing 
the edges of reeds and weeds that might protect the larvae 
from bird or fish, destroying old cans which lie about half- 
filled with rain water, clearing eaves where rain water may 
rest, and such like measures, will soon reduce or totally 
abolish them. Rain barrels or odsterns may be made mosquito 
proof by a layer of oil, the water being drawn off as 
required from below the oil. 


MOUTH AND TEETH 


MOUTH AND TEETH, CAKE OF 

Mouth hygiene, the sanitary mouth, or the care of the 
mouth and teeth is said to have ushered in a new era in 
preventive medicine. It is one of the main points of attack 
in preventing or curing disease, and in the preservation of 
health. 

Importance of the Care of the Mouth. —The mouth is an 
ideal incubator for germs, as it contains food, air, moisture, 
and warmth. Even in healthy mouths bacteria are probably 
always present, while in neglected mouths they are abundant 
and multiply rapidly. 

The Effect of Acids on the Teeth. —Acids destroy the 
enamel and the pulp of the teeth and allow the invasion of 
bacteria which cause abscesses at the roots of the teeth and 
pyorrhoea alveolaris. Devitalized teeth are very prone to 
infection at the roots. The presence of bridgework and 
plates, etc., makes the mouth difficult to keep sanitary and 
gives rise to infection. 

The Effect of a Neglected Mouth on Digestion. —A neg¬ 
lected mouth spoils the appetite and decayed teeth interfere 
with mastication. The pus from abscesses, and the acids and 
bacteria swallowed interfere with digestion. The bacteria 
cause fermentation in the stomach and intestines with the 
formation of gases. 

The Effect of a Neglected Mouth on Other Parts of the 
Body and the General Health. —Infection may spread to the 
sinuses, to the eyes, up the Eustachian tubes, to the ears, to 
the tonsils, to the salivary glands, and the cervical glands. 
From diseased tonsils, rheumatism, endocarditis, and chorea 
may develop. Infection and abscesses at the roots of teeth 
are associated with arthritis, nephritis, gastric ulcer, appen¬ 
dicitis, endocarditis and other serious diseases. From a 
neglected mouth in typhoid a patient may reinfect himself. 
A neglected mouth is a menace to the entire system. 

The kind of patients apt to develop bad mouths, who 
therefore require special care, are: (i) Unconscious or dying 
patients; (2) patients suffering from fevers, such as typhoid 
and pneumonia, in which the lips, tongue, and membranes 
of the mouth become dry and cracked. Food, milk, dried 
epithelial tissue and bacteria get into the cracks, forming 
thick tenacious deposits called sordes, very difficult to 
remove. If not kept clean, very painful ulcers on the 
tongue and cheek, tympanites, and infection of the ears or 
glands result; (3) in many diseases, in almost all forms of 
illness, and in all very ill patients, especially those on 
liquid diet, the tongue becomes furred. 

General Care of the Mouth. —It should be kept clean and 
moist, and cleansed with an antiseptic solution frequently. 


MOUTH, PRE-OPERATIVE CARE OF 

Mouth breathing, and any mechanical or chemical injury to 
the gums with tooth brushes, pastes, or medicines must be 
avoided. 

The Daily Routine Care. —The mouths of convalescent 
patients should be cleansed three times a day, or at least 
in the morning and evening. Very ill patients, patients with 
a high fever, or those with difficult breathing w r ho breathe 
through the mouth, should have their lips and mouths 
cleansed more frequently: they should be cleansed before 
fluids, and the mouth should be well rinsed after fluids. The 
tongue should not be cleansed directly after fluids, as it may 
induce gagging. Special care should be taken in rinsing 
and cleansing the mouth after milk. The patient should be 
given water to drink freely, in order to supply the tissues 
with fluid and keep the mucous membrane of the mouth 
moist and clean. For all sick patients moisten the lips and 
tongue frequently. 

Mouth Washes Commonly Used. —For general purposes the 
following solutions are satisfactory: Listerine and water, 
equal parts; Glycothymolin, one-third strength; Boric acid 
solution; Dobell’s solution, one part in three parts of water 
or Dobell’s solution and Listerine, equal parts; Lemon juice 
and glycerin, equal parts or one dram of lemon juice in 
three drams of glycerin. 

To cleanse the mouth of a very sick patient, remove one 
pillow and turn the patient’s head toward you. Protect 
the patient and the bed by placing a towel under the chin 
across the chest. Open the mouth and examine it before and 
during the procedure. Cleanse all parts thoroughly but use 
the greatest caution not to break or injure the mucous mem¬ 
brane, as this makes it more liable to infection. Cleanse 
with the solution or paste on the patient’s tooth brush or 
on gauze wrapped carefully around a tongue depressor or 
whalebone; use each piece of gauze only once. Avoid making 
the patient gag; avoid touching the back of the throat. Use 
a swab (cotton on a tooth pick) for removing particles 
between the teeth. Allow the patient (if strong enough) to 
rinse his mouth after cleansing, first with an antiseptic 
mouth wash, then with water. When the tongue is parched 
and dry, apply liquid albolene to the tongue with a medicine 
dropper after cleansing. 

MOUTH, PRE-OPERATIVE CARE OF 

The Mouth is of special interest because it comprises 
part of the operative field of the upper and lower jaws, and 
the tongue; it is the path through which the tonsils and 
the adenoids are approached; and the means by which the 
trachea and esophagus are entered. Its main importance from 


MUMPS 


a surgical standpoint is that it can never be rendered 
sterile, so that all the operations on the afore-mentioned 
organs must of necessity be contaminated. Even though the 
work is done in a contaminated field, the same aseptic 
surgery should be practised here as is practised in other 
regions. 

This fact should not deter the nurse from getting the 
mouth as clean as possible for the operation. It is usual 
to have the patient wash the buccal cavity every two hours 
with some liquid, either warm saline, or water to which has 
been added one of the countless pleasant-tasting antiseptics 
which are in every-day use. This should be begun about two 
days prior to the operation. It is imperative that mouth 
washing should be done thoroughly. The nurse should not 
content herself by simply informing the patient that the 
mouth is to be washed, but she should stand by and see 
that it is efficiently done. In addition, the teeth should be 
carefully brushed at least after each meal. If pyorrhea 
exists, the teeth should be scraped and the gums treated 
by a dentist. In this way the amount of mouth contamina¬ 
tion may be reduced to the minimum. 


See Gargles. 


MOUTH-WASHES 


MUCILAGES 

Mucilages are gummy drugs dissolved in water. 


MUMPS (EPIDEMIC PAROTITIS) 

The cause is not yet discovered. The disease is charac¬ 
terized by swelling of the parotid gland and difficulty in 
opening the mouth. There is redness and swelling of the 
opening of Stenson’s duct, accompanied by considerable 
pain; hyper-pyrexia is often present. The chief complica¬ 
tions are orchitis in the male and swollen, painful breast 
in the female. The incubation period is from fourteen to 
twenty-one days. Isolation should be insisted on for three 
weeks, though some doctors claim the disease is not con¬ 
tagious after the swelling disappears. 

The nursing care in general is isolation. Plenty of fluid 
and soft solid food (avoiding acids) must be given during 
the acute stage. Isolation and attention to the diet are the 
chief requirements, in addition to the usual care given to 
any bed patient. The complications are treated with either 
external heat or cold according to the amount of inflammation 
present. In mild cases convalescence is established in a 
short time, but in the more severe type the patient requires 
continued care. 

See Infectious Diseases, Course of. 


MURPHY BUTTON 


MURPHY BUTTON 

See Intestines, Surgical Conditions of. 

MURPHY METHOD 

See Rectum, Administration of Medicine by. 

MUSK (MOSCHUS) 

Musk is the dried secretion of the glands situated in front 
of the prepuce of the Moschus moschiferus, or the musk 
deer of Thibet. It is a dark brown substance, with a very 
strong characteristic odor. Owing to the difficulty of ob¬ 
taining a reliable preparation, musk often produces no ef¬ 
fects. If the preparation is a good one, it produces the 
following effects: 

1. It relieves nervousness and calms and quiets the 
patient. 

2. It is said to make the pulse stronger and faster. 

3. It often relieves hiccough. 

Large doses have occasionally caused headache, dizziness, 
confusion, and muscular twitchings, followed by sleep. It 
is used as an antispasmodic, and occasionally as a heart 
stimulant. The effects wear off very quickly. 

Preparations 

Musk; dose 8 to 15 grains. 

Tincture of Musk; dose 1 to 2 drams. 

MYDRIATICS 

Mydriatics are drugs which cause the pupil of the eye 
to dilate; such as Atropine, Belladonna. 

MYOPIA 

See Accommodation. 

MYRINGOTOMY 

See Ear Nursing. 

MYRRH 

Myrrh is a gum resin obtained from the Commiphora 
Myrrha, an American tree. It contracts skin and mucous 
membranes and is slightly disinfectant. It increases the 
secretions and is said to increase menstruation. It is used 
principally as an astringent; in inflammations of the gums, 
as in mercury poisoning, and as an ingredient of many 
cathartics. 

Tincture of Myrrh; dose 30 to 60 minims. 

MYXEDEMA 

See Thyroid Gland, Diseases of. 


N 


NAPHTHALENE 

Naphthalene is a substance obtained from coal tar. 

Applied to the skin or mucous membranes it checks the 
growth of bacteria. When given internally, it checks the 
growth of bacteria in the intestines, thereby relieving the 
formation of gas. A little of the naphthalene is absorbed 
into the blood, and this is eliminated by the lungs. Here 
it increases the secretion of the mucous membrane and also 
acts as an antiseptic. Most of it is excreted by the feces. 

Large doses cause symptoms like those of carbolic acid 
poisoning. 

Naphthalene is used principally as an intestinal antiseptic 
for tape worms; to increase coughing, and as an antiseptic 
for abscesses in the lungs. 

Preparations 

Naphthalene; dose i to 5 grains. 

Betanaphthol (Naphthol); dose 3 to 10 grains. 

Betanaphthol Benzoate; dose 3 to 8 grains. 

This forms benzoic acid and naphthol in the intestines. 

Betol (Naphtholis Salicylas); dose 5 to 8 grains. 

This forms salol and naphthol in the intestines. 

All these preparations should be given in keratin coated 
pills so that they will be dissolved only by the alkaline 
iuices in the intestines. 


NAPHTHOL 

See Naphthalene. 

NARCOTICS 

See Hypnotics. 

NASAL GAVAGE 

See Gavagjs. 

NAUHEIM OR EFFERVESCENT BATH 

“This consists of a full bath the water of which contains 
chloride of calcium, carbonate of soda, and carbonic acid 
gas.” It is an artificially prepared bath used as a sub- 


NAUSEA (POST OPERATIVE) 


stitute for the natural mineral water of the famous resort of 
Nauheim, Germany. 

The effects are the same and depend upon the proportion 
of chemical substances used. 

Composition of the Bath. —The following ingredients are 
put up in powder form so that one, two or three powders 
may be used according to the intensity of the effect desired. 


Sodium carbonate 
bicarbonate 
Calcium chloride 
Sodium chloride 

bisulphate 


i Yi pounds 

34 


Effects of the Bath. —These chemical irritants added to 
the neutral bath produce a powerful circulatory reaction— 
that is, dilatation of the cutaneous blood vessels, with con¬ 
traction of the adjoining and associated visceral vessels— 
without provoking a thermic reaction. The disadvantages of 
using extremes of temperature, in certain cases, may thus be 
avoided. 

The bath is used in cardiac and renal diseases whert 
extremes of temperature are undesirable or dangerous. 

Method of Procedure. —The tub should be lined with 
rubber to prevent injury to it due to the chemical ingre¬ 
dients. 

The Nauheim baths are very exhausting and therefore only 
to be used with the greatest caution. If dyspnea is present 
the patient must not enter the bath; the breathing must be 
quiet and tranquil. The chest should be wet before entering, 
and the limbs well rubbed during the bath. No exertion must 
be allowed either during or after the bath. 

The baths are carefully graded to suit the patient as 
regards the strength of the ingredients used, the tempera 
ture and the duration of the bath. They should begin with 
the mildest ingredients, at 95 0 F., should last only two 01 
three minutes, and should be given only every other day. 
Even the strongest must not take more than three baths in 
succession without a day’s interval. 

The patient must not be allowed to become chilled before, 
during or after the bath. After the bath the patient should 
be wrapped in a hot sheet, and given friction until dry. He 
should then be allowed to rest for an hour or two. 


NAUSEA (POST OPERATIVE) 

Nausea is usually present after all operations for a short 
time. Some doctors are in the habit of ordering cracked ice 
to relieve this distressing symptom. Whenever it is ordered, 
care must be taken lest the patient get too much and in 


NEOSALVARSAN 


this way imbibe large quantities of cold water with the 
result that vomiting occurs. When the feeling of nausea 
becomes very severe it is accompanied by vomiting. If a 
patient vomits later than twenty-four hours after operation, 
there probably is something in the stomach which is causing 
a persistent irritation. Once this irritation is removed, the 
vomiting will generally cease. It must be remembered that 
the patient has just been operated upon, and that the nerves 
are exhausted, and that conservative treatment is better 
than radical. The most effective procedure for ridding the 
stomach of foreign material is gastric lavage; but washing 
the stomach is trying and tiring and should only be employed 
when other simpler methods have proven unsuccessful. 
First the following should be tried: A glassful or approxi¬ 
mately eight ounces of lukewarm water with about a 
teaspoonful of sodium bicarbonate should be administered 
by mouth. As a rule, patients are very thirsty after opera¬ 
tion, and greedily drink the proffered water. The result is 
that they are further nauseated and soon vomit the ingested 
water, thus washing out the stomach, and instant relief often 
ensues. Sometimes, in spite of these measures, vomiting will 
still persist. It is due then to atony, a relaxation of the 
muscles of the stomach wall. Persistent vomiting is very 
weakening, and gastric lavage should be given almost imme¬ 
diately, if the sodium bicarbonate and water fail to afford 
relief. A post-operative lavage must be of hot water, for 
the heat itself is the efficient agent in stimulating the 
stomach walls to contract, and therefore the water should 
be introduced at about 108-110 degrees Fahrenheit. Another 
point,—as little air as possible should enter the stomach 
tube, and when the lavage is finished, the water should be 
carefully siphoned off from the stomach. If the vomiting 
persists after a good gastric lavage, it then may be due 
either to pernicious vomiting, or possibly, gastric dilatation. 

NEGATIVISM 

Negativism is the tendency to respond to a stimulus in 
a way which is the reverse of the usual reaction. If a pa¬ 
tient is told to put his tongue out, he does the exact op¬ 
posite, shuts his lips tightly to keep his tongue in his mouth. 
Negativism may also be shown by resisting baths and treat¬ 
ment, the taking of food, exercise, etc., and may be caused 
by illusions and hallucinations in which voices tell him not 
to act, or that the food is unfit to eat, etc. 

NEOSALVARSAN 

See Arsenic; and Salvarsan. 


NEPHRECTOMY 


NEPHRECTOMY 

See Kidneys, Surgical Conditions of. 

NEPHRITIS 

Nephritis means inflammation of the kidney. Complete 
rest is the first essential in the treatment of inflammation. 
This can only be provided by lessening the work of the 
diseased organ. The work can'only be lessened by regulation 
of the diet, by lessening the wastes from tissue metabolism, 
by preventing infections, avoiding the use of irritating drugs, 
and by stimulating elimination through the skin and in¬ 
testines. 

The Nursing Care and Treatment. —Rest in bed is essen¬ 
tial. All unnecessary exertion is to be avoided. The pa¬ 
tient may not even be allowed to sit up, because all forms 
of exercise mean increased metabolism and tissue wastes 
to be eliminated and the ashes formed are very irritating to 
the kidneys. For this reason all causes of discomfort and 
restlessness are particularly to be avoided. 

The Diet. —Rest of the kidneys is only possible through a 
carefully regulated diet. It is usually restricted in amount 
and very carefully selected. All foods which irritate or are 
eliminated with difficulty or whose ashes increase the work 
of the kidney are to be avoided. Starvation is also avoided 
as it results in destruction of muscle and other body tissues, 
the ashes of which are irritating and increase the work of 
the kidneys. Protein is restricted to an amount barely to 
meet the body needs. Salt may also be restricted to either 
a “salt-poor” or "salt-free” diet. Salts are restricted par¬ 
ticularly in edema. Sometimec milk alone is given because 
it is low in sodium chloride. It contains sugar and fat (cream 
may be added) and sufficient protein to meet the body needs 
may be given in this way. Fruits contain very little salt, 
so are freely given. Sugar and fats leave little waste for the 
kidney to eliminate. They increase the caloric value and 
prevent tissue destruction, so are usually allowed. Foods 
which irritate , such as celery, onions, radishes, garlic and 
condiments, are to be avoided. Meat extracts and broths are 
also avoided. They have little nutritive value and contain 
sodium chloride, pigments, creatinin, etc., irritating to the 
kidneys. 

Fluids. —When the kidneys are able to eliminate and the 
patient is not edematous, fluids are usually forced, to dilute 
the waste products, flush them from the system, and lessen 
irritation of the kidneys. Water, lemonade, orangeade, and 
imperial drink are given by mouth. Water is also given 
by rectum by means of colon irrigations or the Murphy 
drip. Where the patient is edematous, and in anuria, showing 


NEURONAL 


the kidneys to be impermeable to water, fluids are restricted 
and elimination through other channels is encouraged. 
Thirst which usually results may be relieved by ice or water 
in small amounts. The care of the mouth is very impor¬ 
tant. The amount of fluid, or the “intake,” should be care¬ 
fully measured. 

The condition of the skin is of vital importance. We rely 
on the skin to save the kidneys. It must be kept warm and 
its circulation and functions stimulated. Rest in bed be¬ 
tween blankets, daily cleansing baths and massage aid 
greatly. Chilling must be avoided. All exposure to cold 
air or water is to be avoided. Fresh air without exposure 
is desirable. The care of the skin is also important because 
of the danger of bedsores. 

The Body Eliminations. —To rest the kidneys, elimination 
through all other channels is stimulated. When water is 
allowed fluids are forced to stimulate perspiration. Hot 
fluids are good. Hot baths, hot packs, and drugs (dia¬ 
phoretics) are used for the same purpose. Sweating is 
stimulated, particularly when there is edema. With a good 
sweat it is said that one quart of water and fifteen grains 
or more each of urea and sodium chloride may be eliminated. 
When the blood-pressure is high with arteriosclerosis and a 
hypertrophied heart extreme care must be taken in giving 
hot packs because of their depressing effect on the heart 
and nervous system, etc. 

The bowels are kept open and stimulated by the use of 
cathartics which cause watery movements, especially with 
edema. 

The Avoidance of Infection. —Infections such as colds, 
tonsillitis, ulcerated teeth, and all other infectious diseases 
should be avoided. When the kidneys are diseased their 
resistance is lowered so that they are very susceptible to 
infection by germs as they are being eliminated. 

NEPHROLITHOTOMY 

See Kidneys, Surgical Conditions of. 

NEPHROTOMY 

See Kidneys, Surgical Conditions of. 

neurasthenia 

See Psychoneuroses. 


NEURONAL 

Neuronal is a white crystalline substance having a bitter 
taste and odor resembling menthol. It produces sleep. 


NEUROSES OF STOMACH 


Its effects resemble those of veronal, and it is given in the 
same way. Dose, 5 to 30 grains. 

NEUROSES OF STOMACH 

See Stomach. 

NIPPLES, CRACKED OR FISSURED 

Abrasion or fissure of the nipple is a fertile source of 

pain and inflammation. It may usually be prevented by 
care. The nipples should be hardened during pregnancy. 
(In the last week or two the skin of the nipples may be 

bathed twice a week with eau de Cologne and water (1 to 

3), and on the other days gently massaged with lanoline 
or white vaseline. This tends to toughen the skin.) Each 
time the child is put to the breast the nipple should be 

washed over with sterilized water, and after the child is 
finished, with weak boracic lotion. An occasional spongt- 
with spirit and water is also helpful in preventing the skin 
from becoming sodden. When the patient is up and dressed, 
the nipples should be protected by a clean, soft dressing of 
linen or cotton wool. 

If cracks form they must be kept scrupulously clean. A 
.ittle dressing with boracic lotion may be applied, or a paint 
of Friar’s balsam, or glycerite of tannic acid. Playfair’s 
mixture, containing half an ounce of sulphurous acid, half an 
ounce of glycerite of tannic acid, and an ounce of water, 
is a most useful one. In all cases of fissure the nipple 
should at the same time be protected during suckling by 
a nipple shield. It is important to remember that a fissure 
of the nipple may bleed during suckling, and the child may 
swallow the blood. This it generally vomits later, to the 
great alarm of the mother and nurse. 

NITER, SWEET SPIRITS OF 

See Nitrites. 

NITRATES 

The nitrates are salts formed by the combination of nitric 
acid and an alkali. 

The nitrates are very cooling, and increase the flow of 
urine, and occasionally the secretion of sweat. 

Poisonous Effects 

Overdoses of the nitrates often cause the following symp¬ 
toms. 

1. Burning pain in the throat, and in the abdomen. 

2. Nausea and vomiting; the vomited matter often con¬ 
tains blood. 

3. Diarrhea, with bloody stools. 


NITRITES 


4. Profuse secretion of urine, or scanty urine. 

5. Great muscular weakness. 

6. Collapse, coma and death. 

Preparations 

Potassium Nitrate (Saltpeter) ; dose 5 to 30 grains. 

This preparation is the one which is commonly used. 

Sodium Nitrate; dose 5 to 30 grains. 

NITRIC ACID (AQUA FORTIS) 

Nitric acid acts like other acids, except that it is said to 
increase intestinal secretions and the secretion of bile. 
It is occasionally used instead of hydrochloric acid to aid 
digestion. A drop of the strong acid is frequently applied 
on the skin to destroy an infected area. 

Dilute Nitric Acid; dose 10 to 30 minims. 

This contains 10 per cent, of nitric acid. 

For Local Use: Nitric Acid. 

This contains 68 per cent, of nitric acid. 

See Acids, Inorganic. 

NITRITES 

AMYL NITRITE 

Amyl nitrite is a yellow fluid which evaporates easily, 
and has a characteristic odor of fruit. 

About three to five minutes after an average dose of amyl 
nitrite is inhaled, the face becomes flushed, and sometimes 
the skin all over the body as well. The patient complains 
of fullness and throbbing in the head, and often of severe 
headache. The pulse is rapid, soft and bounding, and the 
breathing is rapid and somewhat deeper. These symptoms 
last for about ten to fifteen minutes, and then pass off. 

Administration 

Amyl nitrite is usually given by inhalation. It comes in 
small glass “pearls,” each containing about 3 to 5 minims 
of amyl nitrite, which are broken in a handkerchief and 
then applied to the nose of the patient. The handkerchief 
should be withdrawn as soon as the effects are produced. 
Amyl nitrite is occasionally given hypodermically. It is also 
given by the mouth; about 3 to 5 minims dropped on a 
piece of sugar; but the effects then appear very slowly. 

Uses 

Amyl nitrite is used for the following effects. 

1. To relieve an attack of “angina pectoris,” a disease 
characterized by attacks of severe pain around the heart, 
and shooting pains into the left arm. 

2. To relieve an attack of bronchial asthma. 


NITRITES 


ACTION OF THE NITRITES 

Appearance of the Patient 

The effects that result from the use cf the nitrites are the 
same as those following amyl nitrite, but they appear very 
slowly. All the nitrites with the exception of nitroglyc¬ 
erin, may cause nausea and vomiting. 

Action after Absorption 

The nitrites are very rapidly absorbed into the blood, 
through the lining membrane of the stomach. After absorp¬ 
tion, they affect principally the blood vessels, the respiration 
and the kidneys. 

Action on the blood vessels: The nitrites affect prin¬ 
cipally the blood vessels. They paralyze the small involun¬ 
tary muscle fibers in the walls of the small blood vessels. 
As a result, these blood vessels are widened, so that it is 
easier for the blood to pass through them, and the blood 
pressure is lessened. The heart contracts faster, however, 
because the wider blood vessels offer very little resistance 
to the contractions of the heart, which then contracts with 
greater ease. By the action on the blood vessels, the nitrites 
ease the action of the heart, when it is overworking be¬ 
cause of increased blood pressure, or because of spasmodic 
contractions of the blood vessels. 

The blood vessels of the abdomen and head are more 
affected than those of the extremities. 

The total effect of the nitrites on the circulation is to 
make the heart beat faster, and to lower the blood pressure. 
Consequently the pulse is rapid, soft and bounding. 

Action on the respiration: The nitrites make the breath¬ 
ing faster and deeper. 

Action on the kidneys: The flow of urine is often in¬ 
creased by the nitrites, when the kidneys do not secrete a 
sufficient amount of urine, because of the high blood pressure. 
The better circulation of blood in the kidneys as a result of 
the widened blood vessels, increases the secretion of urine. 

Excretion 

The nitrites are excreted by the urine, usually in about 
one or two hours. 

Poisonous Effects 

Poisonous symptoms usually occur suddenly from the 
inhalation of an overdose of amyl nitrite. After prolonged 
administration of the other nitrites the same symptoms 
occur, but more gradually. 

Symptoms. — i. Flushing of the face and neck. 

2. Intense, throbbing headache (a feeling of a tight band 
around the head or as if the “head were coming off”). 


NITRITES 


These symptoms frequently occur from an ordinary dose 
of amyl nitrite, but soon pass off. Occasionally from a single 
dose of amyl nitrite, and from continued use of other 
nitrites the following symptoms may also occur: 

3. Faintness. 

4. Dizziness. 

5. Dilated pupils. 

6. Slow, irregular pulse. 

7. Confusion of ideas. 

8. Collapse. 

The symptoms usually improve when the patient is lying 
down or when the drug is stopped. 

Administration 

The nitrites should be given in a wineglassful of milk 
after meals. If tablets are used these should be dissolved 
in the milk. 

Uses 

The nitrites are given principally in repeated doses for a 
long time, in the following conditions: 

1. Arteriosclerosis, or hardening of the arteries. 

It relaxes the contractions of the arteries whose muscle 
libers have not yet been replaced by connective tissue. In 
many cases nitroglycerin produces no effect, as the muscle 
fibers have been replaced by fibrous tissue, which is not 
elastic. 

2. To reduce blood pressure, in nephritis. 

3. To relax the contractions of the involuntary muscles 
in the bronchi, in asthma. 

4. To prevent the attacks of angina pectoris by keeping 
the muscles of the coronary blood vessels of the heart re¬ 
laxed. 

NITROGLYCERIN 

Nitroglycerin or spirits of glonoin, is a colorless, oily 
liquid which has an odor and taste like alcohol. Prep¬ 
arations- of nitroglycerin should be very carefully handled, 
as it is apt to explode when dropped on the floor, when 
heated, or when rubbed vigorously. If it is accidentally 
spilled, it should be destroyed immediately, by pouring 
potassium hydroxide solution over it. 

A 1 per cent, alcoholic solution is used as a medicine, 
which unould always be kept cool, as it may explode when 
exposed to heat. 

Preparations 

Spirits of Glyceryl Trinitrate (Nitroglycerin or Spirits 
of Glonoin) ; dose ^ to 3 minims. 

This is a 1 per cent, alcoholic solution of nitroglycerin. It 
should always be fresh, as it decomposes very easily. 


NITRITES 


Tablets of Nitroglycerin; each containing Vioo of a grain. 

i to 2 tablets are given at a time. 

These are not as efficient as a solution of the drug, and 
they decompose very easily. 

SODIUM AND POTASSIUM NITRITES 

They produce the same effects as amyl nitrite or nitro¬ 
glycerin, with the following variations: 

1. Their effects appear very slowly, usually in about a 
half hour, but they last for several hours. 

2. They often cause nausea, belching of gas, and pain in 
the stomach, and occasionally diarrhea. 

3. They do not cause as much headache or flushing of 
the face as amyl nitrite or nitroglycerin does. 

Uses 

The nitrite of either sodium or potassium is suitable for 
continued use, to lower the blood pressure. 

Preparations 

Sodium Nitrite; dose 1 to 2 grains. 

This is given in solution or in tablets. 

Potassium Nitrite; dose 1 to 2 grains. 

These preparations produce the same effects as nitro¬ 
glycerin, but the effects appear more gradually and are 
more lasting. The effects usually appear in about 15 min¬ 
utes and last for about 3 or 4 hours. 

SWEET SPIRIT OF NITER (SPIRITUS ^ETHERIS NITROSl) 

Sweet spirit of niter is a 4 per cent, solution of nitrous 
ether, or ethyl nitrite, in alcohol. It evaporates very easily 
and is inflammable. It should always be fresh, as old solu¬ 
tions decompose. 

Sweet spirit of niter produces the same effects as nitro¬ 
glycerin or the other nitrites. 

It dilates the blood vessels by paralyzing their muscle 
fibers, and causes: 

1. A rapid, soft, bounding pulse. 

2. Rapid breathing. 

3. Increased flow of urine, by relaxing the blood vessels 
of the kidneys. 

4. Increased secretion of sweat, by widening the blood 
vessels of the skin, so that the sweat glands are supplied 
with more blood from which to secrete perspiration. 

Poisonous Effects 

Inhalation of sweet spirit of niter has produced danger¬ 
ous, even fatal symptoms, resembling those produced by 
amyl nitrite. 

Symptoms.— 1. Headache. 


NOSE 


2. Pain around the heart. 

3. Weak, slow pulse. 

4. Slow, shallow breathing. 

5. Muscular weakness. 

6. Collapse. 

Uses 

Sweet spirit of niter is used to increase the sweat and 
thereby to reduce fever, especially in children. It is given 
in small doses, well diluted; and the patient should be kept 
in bed, warmly covered. If the skin is kept cool, it in¬ 
creases the flow of urine. 

Preparation 

Spirit of Nitrous Ether (Sweet Spirit of Niter) ; dose 
15 to 60 minims. 

NITROGLYCERIN 

See Nitrites. 

NITROHYDROCHLORIC ACID 

Nitrohydrochloric acid or aqua regia, is a mixture of one 
part of nitric and 4 parts of hydrochloric acid. It is the 
most powerful acid, and the only fluid which will dissolve 
platinum and gold. 

This acid diluted is principally used to increase the flow 
of bile, given in the following ways: 

1. By mouth, sipped through a glass tube. 

2. In a foot bath or ordinary bath. 

3. It is said to be more efficient if it is applied to the 
liver in the form of a stupe, about 1 to 2 drams of the 
dilute acid being used to a pint of water. 

Preparation 

Dilute Nitrohydrochloric Acid; dose 5 to 15 minims. 

This contains 40 parts of nitric acid and 180 parts of 
hydrochloric acid in 1000 c.c. of water. 

See Acids, Inorganic. 

NITROUS OXIDE 

e Anesthetics 

NOSE 

The nose is the special organ of the sense of smell, but 
it also serves as a passageway for the entrance of air to 
the respiratory organs. It consists of two parts—the ex¬ 
ternal feature, the nose, and the internal cavities, the nasal 
fossae. 

The external nose is composed of a triangular framework 


NOSE 


of bone and cartilage, covered by skin and lined by mucous 
membrane. On its under surface are two oval-shaped 
openings—the nostrils, which are the external openings of 
the nasal fossae. The margins of the nostrils are provided 
with a number of stiff hairs, which arrest the passage of 
dust and other foreign substances which might otherwise be 
carried in with the inspired air. 

The nasal fossae are two irregularly wedge-shaped cavities, 
separated from one another by a partition, or septum. The 
septum is formed partly by the vertical plate of the ethmoid, 
partly by the vomer, and partly by cartilage. 

The nose serves the very important function of filtering, 
warming, and moistening the air. In addition to aiding 
the sense of smell, it also gives the voice some of its quali¬ 
ties. 

Deviated Septum.—In this condition one or both sides of 
the nose are occluded by a deformity of the nasal septum, 
and an attempt is made to remove the obstructing car¬ 
tilage by a submucous resection preserving the mucous mem¬ 
brane of the septum. After the operation has been com¬ 
pleted, each nasal cavity is packed with strips of sterile 
gauze. The packing is removed after twenty-four hours. 

Hypertrophy of the Turbinates.—The turbinates are small 
bones, three in number, found along the outer wall of each 
nasal cavity. Occasionally these increase in size and ob¬ 
struct free respiration. They may be reduced by chemical 
irritants, cautery, or partially removed by cutting them with 
a wire snare. Occasionally, hemorrhage may follow the 
removal of part of the turbinate bones. This may be con¬ 
trolled by spraying in some adrenalin solution, syringing 
the nose with hot water (temperature about 120 0 F., or 
plugging the nose with cotton. Most of these operations 

are done under novocaine. 

Sinusitis.—The sinuses of the nose may be frequently in¬ 
volved during a cold, and very often the frontal, ethmoidal, 
sphenoidal sinuses or the antrum may be the seat of infec¬ 
tion. This condition is recognized by pain in the region 

of the sinus involved, discharge, and tenderness on pressure 
over the sinus. The treatment consists in establishing free 
drainage. In the case of the antrum of Highmore, this is 
done by puncture of the sinus and daily irrigations through 
the nose. 

Foreign body in the Nose.— Make pressure on the opposite 
nostril and have patient take a deep breath through the 

mouth and then close it. Thus the air may force the 

obstacle out. Or, while pressing on the opposite nostril, 
blow the nose hard or induce sneezing by tickling the inside 
of the nostril, or having a little pepper in the air. 


NTJX VOMICA 


NOSE-BLEED 

See Epistaxis. 

NOVASPIRIN 

See Salicylic Acid. 

NOVATOPHAN 

See Atophan. 

NOVO CAINE 

Novocaine is an artificial alkaloid which is used as a local 
anesthetic. It acts like cocaine, but it is less poisonous 
and its effects wear off quickly. It is usually given to- 
together with epinephrin. 

Preparations 

Novocaine Tablets. Each tablet contains % to 3 grains. 

There are also tablets containing novocaine and adrenalin. 

Novocaine Nitrate; dose Vs to 3 grains. 

It is usually used in a 3 per cent, solution. 

See Cocaine. 

NUTGALL 

Nutgall is a growth which forms on the bark of the 
gall oak tree, by the punctures and the deposited eggs of 
a species of fly. Before the larvae are formed from the ova, 
the galls contain about 50 per cent, of tannic acid and smaller 
quantities of gallic acid. 

Nutgall contracts the tissues and checks the secretion of 
mucous membranes because of the tannic acid which it con¬ 
tains. It is little used except in the form of an ointment, as 
a local application for hemorrhoids. 

Preparations 

Tincture of Nutgall; dose one-half to three drams. 

Nutgall Ointment. 

Gall and Opium Ointment. 

This contains 7^2 per cent, of opium. 

NUX VOMICA AND STRYCHNINE 

Nux vomica is obtained from the seeds of the Strychnos 
nux vomica, and Strychnos ignatia. 

The active principles are two alkaloids: strychnine and 
brucine. The effects of both are the same; brucine being 
half as strong as strychnine. 

The action of nux vomica is due to the strychnine which 
it contains, so that the effects of the drug are the same as 
those of its active principle. 

Internal Action: In the mouth: Strychnine has a very 
bitter taste; it increases the appetite and the flow of saliva. 


NUX VOMICA 


In the stomach: Strychnine increases the secretion of 
gastric juice, and the peristalsis of the muscle wall of the 
stomach. 

In the intestines: It increases the secretion of the mucous 
membranes and the peristalsis. Frequent movements of 
the bowels then result. 

Action after Absorption. —Strychnine is absorbed into the 
blood mainly from the intestines, in about one or two hours. 
After absorption, it affects principally the circulation, the 
respiration, and the spinal cord. 

The effect of strychnine on the circulation is to make the 
heart beat slower and stronger. The characteristic strych¬ 
nine pulse is slow and strong. 

Action on the respiration: The breathing is deeper and 
faster. 

Action on the nervous system: Strychnine increases the 
appreciation of all the various sensations; thus pain is felt 

more keenly, and all the senses become more acute. 

Reflex action and all the activities of the body which are 
affected by impulses received through the various sensory 
nerves are increased. 

In this way, strychnine acts as a tonic, improving the 
activity of every part of the body. The patient responds 

better and more readily to all the impressions received 
through the various senses. After continued strychnine ad¬ 
ministration the individual is therefore able to do more 
work. The appetite and digestion are better, and the 

bowels move more often, because of the increased reflex 
action which makes the gastric and intestinal muscles re¬ 
spond more easily to any substance, affecting their mucous 
membranes. The heart beats stronger, and the breathing is 
more rapid and deeper. As a result of all these effects 
on the various organs of the body, the patient feels 
stronger, healthier, and his general condition is improved. 

Poisonous Effects 

Strychnine poisoning occurs in two forms: acute poison¬ 
ing and cumulative poisoning. 

Acute Strychnine Poisoning 

Acute strychnine poisoning usually results from an over¬ 
dose of strychnine, or when a preparation of the drug is 
taken with suicidal intent. The symptoms appear very 
soon after it is taken, usually in about fifteen minutes. 

Symptoms. — i. The patient complains first of stiffness of 
the muscles of the neck or face, and of slight stiffness of 
the jaw; soon there follows twitching of the face or arms. 

2 . Sudden tetanic convulsions of the whole body then 


NUX VOMICA 


occur. The arms and legs arc rigid and extended. The 
head is drawn hack, and the back is bent so that it forms a 
concavity (opisthotonus). The contractions of the facial 
muscles draw up the corners of the mouth, causing a pe¬ 
culiar grin and ghastly expression known as the “risus 
sardonicus.” 

The convulsions are due to the increased reflex action, 
and are brought on by the slightest stimulus, such as a gust 
of air, the touch of a blanket, a flash of light or the slam 
of a door. After the convulsion, all the muscles are re¬ 
laxed and there is a feeling of soreness, but the slightest 
touch, a gust of wind, or a loud noise, at once produces an¬ 
other paroxysm. 

3. The contractions of the muscles of the diaphragm, 
during the convulsions, give the face and lips a blue color, 
from the lack of oxygen in the blood, due to the interfer¬ 
ence with the breathing. 

4. The pulse is slow and stronger, but during the convul¬ 
sions it is often rapid and weak. 

5. The convulsions become more frequent and often 
clonic in character, and the patient finally dies of asphyxia, 
in about two or three hours, the mind remaining clear to 
the end. 

Treatment. — 1. Give tannic acid or tea to combine with 
the strychnine. 

2. Wash out the stomach or give emetics (but not during 
the convulsions) if strychnine has been taken by the mouth. 

3. If the patient has convulsions, give ether to control 
them, and then wash out the stomach. 

4. To prevent the convulsions from returning, chloral or 
bromides arc given repeatedly. 

5. Catheterize; to prevent reabsorption of the strych¬ 
nine from the urine. 

6. Give artificial respiration and oxygen when the patient 
is blue and cyanotic. 

Cumulative Strychnine Poisoning 

Since strychnine is rapidly absorbed and very slowly 
excreted, some of it always remains in the body when it is 
given continuously, and often causes cumulative symptoms. 
These symptoms, which result from the accumulation of 
strychnine in the body, arc the same as the acute symptoms, 
but they develop more slowly. 

Symptoms. — 1. The earliest symptoms which indicate that 
the patient is getting too much strychnine, are twitching of 
the muscles of the face or of the extremities, such as 
shrugging of the shoulder or twitching of the fingers. 

2. Often the earliest symptom may be diarrhea. 


NUX VOMICA 


3. Soon the patient complains of stiffness of the neck 
and jaw or in the muscles of the face. 

If the drug is continued, convulsions may occur. 

Treatment. —Stop the drug as soon as the earliest symp¬ 
toms are noticed. This enables the strychnine in the body 
to be eliminated, and further symptoms are avoided. If 
other symptoms occur, the treatment is the same as for 
acute poisoning. 

Uses 

Strychnine is used principally for the following effects: 

1. As a heart and respiratory stimulant in collapse. 

2. In various forms of paralysis, to increase the contrac¬ 
tions of the muscles. 

3. As a tonic, to improve the general health and strength 
of the body. 

4. To increase the appetite and to improve the action of 
the bowels. 


Administration 

For rapid effect in collapse, strychnine should be given 
hypodermically. 

To increase the appetite, nux vomica is usually given be¬ 
fore meals, undiluted. 

Preparations 

Extract of Nux Vomica; dose 1/4 to 1 grain. 

Fluidextract of Nux Vomica; dose 1 to 5 minims. 

Tincture of Nux Vomica; dose 5 to 15 minims. 

This is the preparation most frequently used as a tonic. 

Strychnine; dose to Vi 5 of a grain. 

Strychnine Sulphate; dose Vio to Vis of a grain. 

This is the preparation used hypodermically in collapse. 
In hospital practice it comes in a 1 per cent, solution or 
v'eaker. 

Strychnine Nitrate; dose Vio to Vi 5 of a grain. 

Iron and Strychnine Citrate; dose 1 to 3 grains. 


0 


OAK 

See Quercus. 

OILS 

Oils are substances which have a characteristic greasy 
feel and with whose physical characteristics the reader is no 
doubt familiar. Chemically they consist of a mixture of 
three substances: olein, stearin and palmitin, the three ele¬ 
mentary fats. Each of these substances consists in turn of 
a fatty acid combined with glycerin. Oils are of two kinds: 
fixed and volatile. 

Fixed oils comprise most of the oils in common use, such 
as olive, cottonseed and castor oil. The fixed oils do not 
evaporate easily. They are decomposed in the intestine by 
the digestive juices into a fatty acid and glycerin. The 
rancidity of fats and oils is due to a similar decomposition 
by heat. 

The oils are utilized as foods, and medicinally they are 
very soothing substances. Many oils, however, such as 
castor oil and croton oil, when decomposed in the intes¬ 
tines form fatty acids which act as drugs. 

Volatile oils are oils which evaporate very readily. When 
a volatile oil is allowed to stand for some time, some of its 
constituents evaporate, leaving a thick film which is called 
a stearoptene. 

Volatile oils usually have a very pleasant aroma which 
gives the pleasant odor to the plants from which they are 
obtained. They are often called essential oils. The most 
common volatile oils are turpentine oil, oil of wintergreen, 
oil of peppermint, oil of camphor, etc. 

OIL OF VITRIOL 

See Sulphuric Acid. 


OINTMENTS 

Ointments are preparations which are usually made up 
with lard, vaseline, or oils. They are applied to the skin 


OLEATES 


and are melted by the heat of the body and the drugs are 
then absorbed. 

Ointment may be applied for a local or a general effect. 
They are the best means of applying remedies for a pro¬ 
longed local effect. The fat in which the drug is contained 
dissolves readily but does not evaporate, thus prolonging the 
effect of the drug on the site of application. 

The ointment should be spread on a piece of flannel or lint 
and applied to the site ordered; it should be changed fre¬ 
quently; about every day. Ointments should be avoided on 
discharging wounds as they prevent free drainage of the 
secretions. For a general effect they are applied by rub¬ 
bing. 

OLEATES 

Oleates are medicinal substances dissolved in oleic acid, 
Vvhich is an ingredient of many oils and fats. Oleates are 
more easily absorbed than ointments. 

OLEORESINS 

Oleoresins are extracts of plant drugs made by dissolving 
the crude drug in acetone or ether. They contain the 
resinous substance and oils of the plant. 

OLEUM MORRHU^S 

See Cod Liver Oil. 

OLEUM RICINT 

See Castor Oil. 

OLEUM TIGLII 

See Croton Oil. 

OPIUM 

Opium is the hardened dried juice of the unripe capsules 
ef the Papaver somniferum or white poppy, a plant which 
grows principally in Turkey, Asia Minor, Persia, India and 
China. The drug is obtained by making a longitudinal or 
transverse cut in the capsule, when a thick, white, milky juice 
oozes out. This is exposed to the air, and allowed to dry, 
when it turns brown and hard. This dried juice is the 
crude opium, from which all the preparations are made. It 
has a peculiar characteristic odor. 

Opium relieves pain better than anything else, no matter 
what the cause of the pain may be. 

Active Principles 

The active principles of opium are the following alkaloids: 
Morphine; Papaverine; Codeine; Narcotine; and Thebaine. 


OPIUM 


Opium also contains a number of other unimportant sub¬ 
stances. 

The action of opium is due principally to the morphine 
which it contains, amounting usually to 9 per cent, of the 
drug. 

Appearance of the Patient 

About ten to fifteen minutes after giving an average dose 
of opium or morphine, the patient complains less of the pain 
from which he may have been suffering. He becomes calm, 
abstracted and quiet, and feels comfortable. When spoken 
to, he may not answer, because of his drowsy, abstracted 
condition; he may lie in a quiet, dreamy state. 

Soon, however, the patient falls into a light sleep from 
which he can be easily aroused; often the sleep is deeper, re¬ 
sembling the natural sleep. The breathing is slow and 
shallow, the pulse is perhaps somewhat slower, the face 
is flushed, the pupils are contracted and the skin may be 
moist. These effects last for several hours, and gradually 
wear off, leaving the patient feeling dull and depressed, with 
dryness of the throat and occasionally a slight headache 
and nausea. 

Local action: Applied to the skin, opium or morphine 
produces no effect. 

Mucous membranes are contracted, and the secretions 
are checked by opium or morphine. It may be slightly 
absorbed from wounded surfaces and mucous membranes 
when locally applied to them, but whatever effects then 
result are due to absorption. 

Action after Absorption. —Morphine is very rapidly ab¬ 
sorbed into the blood through the mucous membrane of the 
stomach, usually in about ten or fifteen minutes. It can 
also be absorbed from all the mucous membranes. When 
given hypodermically, it acts in about two to five minutes. 
Opium preparations are absorbed more slowly. After ab¬ 
sorption, opium and morphine affect principally the brain, 
the respiration, the secretory glands and the pupil. 

Action on the Nervous System 

On the brain: Opium or morphine lessens all the activi¬ 
ties of the brain except the imagination, which is frequently 
made more active. 

On the sensory areas: It lessens the activities of all the 
sensory areas of the brain. Thus the appreciation of all 
sensory impulses, especially that of pain, is lessened. Since 
consciousness is the result of the sensory impressions re¬ 
ceived through our sensations, by lessening the apprecia¬ 
tion of the sensations, opium or morphine produces uncon¬ 
sciousness or sleep. When the patient is unable to 


OPIUM 


sleep on account of pain, these drugs are particularly 
valuable. The sleep is light, however, and the patient may 
be easily awakened. Often it is deeper and resembles the 
natural sleep. 

On the motor areas: The action of the motor areas of the 
brain is slightly lessened, so that the patient is not quite 
so active. 

On the mental activities: The higher mental activities 
of the brain, such as will power, judgment, reasoning, and 
concentration are all lessened. 

Action on the respiration: Opium or morphine makes the 
breathing slower and shallower by lessening the impulses 
for breathing, sent out from the respiratory center in the 
medulla. 

Action on the circulation: It produces no effect on the 
heart. 

The blood vessels of the face and neck are dilated, how¬ 
ever, causing a flushed face and a feeling of warmth. 

The pulse after opium or morphine is usually normal and 
strong. With larger doses, the pulse is somewhat slower. 

Action on the secretory glands: Opium or morphine 
checks all the secretions except the sweat, which it in¬ 
creases. The perspiration is increased more by the prep¬ 
arations of opium than by those of morphine. 

Action on the involuntary muscles: The contractions of 
the involuntary muscles are lessened. Intestinal peristalsis 
is thus lessened; which, in addition to the diminished se¬ 
cretion of the intestines, causes constipation. 

Action on the pupil: Opium or morphine contracts the 
pupil. It makes the pupil very small when given internally. 
When applied locally to the conjunctiva it produces no 
effects. 

Excretion 

Opium or morphine is rapidly eliminated from the body, 
mainly by the digestive tract, into the stomach, intestines 
and saliva and slightly by the urine, usually in about an 
hour. The drug is frequently absorbed again from the 
stomach and intestines. 

Summary of Effects 

The most important effects of opium or morphine are the 
following: 

1. It relieves pain. 

2. It makes the breathing slower. 

3. It lessens all the secretions, except the sweat; which is 
increased. 

4. It checks peristalsis, producing constipation. 

5. It contracts the pupil. 


OPIUM 


Idiosyncrasies 

a. Idiosyncrasies of Effect. —In some individuals, the fol¬ 
lowing unusual effects occasionally occur: 

1. Weakness and depression. 

2. Continued nausea and vomiting. 

3. Delirium and excitement. (This is especially apt to 
occur in women.) 

4. Convulsions. 

5. Redness of the skin and itching when the effects are 
passing off. 

6. Diminished secretion of urine, especially in cases of 
nephritis. 

b. Idiosyncrasies of Dose. —In some individuals a very 
small dose may cause very deep sleep, and even poisonous 
effects. In others, a very large dose may cause no effects 
at all, or only slight effects. Old people and children are 
very susceptible to opium or morphine. They may get 
poisonous symptoms from very small quantities. 

Poisonous Effects 
Acute Opium Poisoning 

Acute opium poisoning usually results from an overdose 
given medicinally, or when a preparation is taken with 
suicidal intent. Old people and children are very susceptible 
to morphine. 

Symptoms. —Since the most striking effect of opium is 
sleep, the symptoms are divided into three stages, according 
to whether the patient can be aroused from the sleep, 
whether he can be aroused with difficulty (stupor) o»- 
whether he cannot be aroused at all (coma). 

Symptoms of the First Stage.—1. Slow, shallow breath¬ 
ing. (This frequently occurs from an ordinary dose.) 

2. Slow, strong pulse. 

3. Flushed face. 

4. Contracted pupils. 

5. Profuse perspiration. 

6. Sluggish mentality, inattentiveness, perhaps sleep. 

If a very large dose has been taken, these symptoms may 
last for a very short time, or they may be absent entirely, 
and are soon followed by— 

The Second Stage or Stage of Stupor.—1. The sleep is 
very deep, and the patient can be aroused only with great 
difficulty. If spoken to in a loud voice, or when he is 
shaken and his attention attracted, he may brace up for 
a few minutes; but he soon falls asleep again. 

2. The breathing is very slow and shallow, about 4 to 10 
times a minute. 

3. The. pulse is slow and strong. 


OPIUM 


4. The pupils are contracted (“pin point pupils” be¬ 
cause they are very small). 

5. The skin is blue (cyanotic), because the blood does not 
get enough oxygen on account of the slow and shallow 
breathing. 

6. The skin is covered with perspiration. 

These symptoms last for a short time, and the patient 
soon passes into— 

The Third Stage or Stage of Coma.—1. The patient now 
lies in a very deep sleep, from which he cannot be aroused. 

2. The breathing is very slow and shallow, about 3 to 4 
times a minute. It often becomes periodic (Cheyne-Stoke’s 
Respiration). 

3. The pulse is rapid and weak. 

4. The skin is blue (cyanosis). 

5. Pin point pupils. 

The breathing finally becomes still slower, the pupils 
dilate, and the patient dies from paralysis of the respiration, 
though the heart may beat for several minutes afterwards. 

Synopsis of Poisonous Effects. —The following are char¬ 
acteristic symptoms of acute opium or morphine poisoning: 

1. Sleep, stupor, followed by coma. 

2. Slow and shallow breathing. 

3. Slow pulse. 

4. Contracted pupils, “pin-point pupils.” 

5. Cyanosis. 

6. Profuse perspiration. 

Treatment.—1. Wash out the stomach, with plain water, 
or better still, with a 112000 potassium permanganate solu¬ 
tion, which makes the drug inactive. The washing should be 
repeated every half hour until the patent is entirely out of 
danger. Even if the drug is given hypodermically, the 
stomach should be washed out, as the drug is excreted into 
the stomach, and repeated washings help to eliminate it. 

2. If the stomach cannot be washed out, for lack of ap¬ 
paratus, etc., or if a solid preparation has been taken, 
emetics should be given repeatedly, about every 15 minutes. 

A tablespoonful of mustard in a glass of water, zinc sul¬ 
phate 10 to 30 grains, copper sulphate 5 to 10 grains may 
be given to produce vomiting, and potassium permanganate 
to destroy the drug. 

3. Atropine, Vioo of a grain, is given. This is the antidote 
for morphine. It should be repeated every hour until the 
breathing becomes deep and rapid again. It should never 
be given without the doctor’s orders, however, as atropine 
poisoning may result from its injudicious use. 

4. Apply cold douches on the skin, rub or strike the pa¬ 
tient with wet towels. This keeps him awake and increases 


OPIUM 


the breathing. Care must be taken, however, not to cause 
exhaustion by too violent measures. 

5. Keep the patient warm. 

6. Catheterize. 

7. Keep up artifical respiration continuously. 

8. Respiratory stimulants, such as caffeine, or a hot 
coffee enema, strychnine, etc., are given and should be fre¬ 
quently repeated. 

9. The application of the faradic current to the vagus 
nerve in the neck may help the respiration in some cases. 

The treatment of opium poisoning should be kept up for 
hours, as long as the patient is alive. Patients have recov¬ 
ered from as much as 30 grains of morphine, by persist¬ 
ent treatment. 

Chronic Opium Poisoning or Opium Habit 

The opium habit occasionally results in patients to whom 
it has been necessary to give opium or morphine for a long 
time. The pleasant effects of the drug and the ease with 
which it relieves pain and suffering often induce the habit. 
The drug is usually taken in the form of opium pills or lau¬ 
danum. Hypodermic injections of morphine is one of the 
commonest ways in which the drug is taken. 

Symptoms. —The characteristic symptom is the great 
craving for the drug. The other symptoms vary according 
to whether the patient is without his drug or under the 
influence of his usual dose. 

When the habitue is not under the influence of the drug 

he usually has profuse sweating followed by abdominal 
cramps, twitching of the muscles and uncontrollable yawning. 
He is irritable and nervous. He is unable to do his work 
because he cannot concentrate his mind on anything. 

When he gets his usual dose these symptoms disappear; 
he braces up, becomes energetic and is able to work, and 
he then feels quite comfortable. In many habitues there are 
no other effects. Usually, however, the devotee passes into 
a drowsy, dreamy state during which he has so much pleas¬ 
ure that he forgets—his physical pains, his cares, his wor¬ 
ries, even his responsibilities. Many lie in this state for 
hours and fall into collapse when they attempt to get up. 
Finally, the habitue falls into a deep sleep lasting for sev¬ 
eral hours, and gradually awakes with headache, nausea and 
weakness. 

Prolonged use, however, ultimately undermines both body 
and mind. The individual becomes thin and anemic. He 
has a loss of appetite and various other digestive disturb¬ 
ances. He is usually very constipated, although he may have 
attacks of pro-fuse diarrhea, He becomes dull and listless, 


OPIUM 


with no self-control, no ambition and with no sense of truth 
or honor. Morphine habitues are most inveterate liars and 
can-not be trusted. Many of them develop all sorts of de¬ 
praved moral tendencies and others become maniacal or 
insane. 

They usually have a regular pulse, contracted pupils and 
irregular temperature. The arms may be full of needle 
marks and occasionally an abscess develops from the use of 
unsterilized needles. 

The habit is treated by gradually withdrawing the drug, 
the administration of drastic cathartics, and hyoscine as 
an antidote. Stopping the drug suddenly may cause col¬ 
lapse. 

Uses 

Opium or morphine is used for a great many conditions. 
In fact, there is hardly a condition or disease in which this 
drug is not useful. It is used principally: 

1. To relieve pain. For this purpose it is the best and 

most reliable drug. 

2. To produce sleep, especially when the patient is unable 
to sleep on account of pain. 

3. To lessen peristalsis and produce constipation. 

4. To check the secretions, except the sweat. 

5. To lessen all forms of nervous excitement, such as 
delirium tremens, convulsions, tetanus, etc. 

Administration 

For rapid effects, morphine, given hypodermically, is 

the best preparation to use. Opium is better where con¬ 
stipation is desired. 

Preparations 

Powdered Opium; dose i/fc to 2 grains. 

This contains 12 per cent, of morphine. 

Deodorized Opium; dose % to 2 grains. 

This contains 12 per cent, of morphine, but its odorous 
substances have been removed. 

Pills of Opium; dose 1 pill. 

Each pill contains 1 grain of powdered opium. These 
pills must be freshly made, as otherwise they accumulate 

in the stomach and cause poisonous effects. 

Extract of Opium; dose 14 to 1 grain. 

This contains 20 per cent, of morphine. 

Powder of Ipecac and Opium (Dover’s powder); dose 10 
grains. 

Each powder contains 1 grain each of ipecac and opium, 
and 8 grains of milk sugar (it contains 10 per cent, of 
opium). Dover’s powder is taken at night in hot lemonade, 


ORTHOFORM 


to break up a cold. It increases the perspiration very mark¬ 
edly. 

Opium Plaster. 

This contains 6 per cent, of opium. 

Tincture of Opium (laudanum); dose 5 to 15 minims. 

This contains 10 per cent, of opium. 

Tincture of Deodorized Opium (McMunn’s elixir); dose 
5 to 15 minims. 

This contains 10 per cent, of opium. It contains no nar¬ 
cotine, and no odorous principles, and is therefore more 
pleasant to take. 

Camphorated Tincture of Opium (Paregoric); For Adults, 
1 to 4 drams. 

For children .—Under 1 year, 1 to 5 minims. 

Under 2 years, 5 to 15 minims. 

Under 3 years, 5 to 20 minims. 

Under 5 years, 5 to 25 minims. 

Under 10 years, 15 to 30 minims. 

Paregoric contains 2 grains of opium to 1 dram, together 
with camphor, benzoic acid, oil of anise and glycerin. It 
is the best preparation of opium to use for children. 

Tincture of Ipecac and Opium (Tincture of Dover’s 
powder); dose 5 to 15 minims. 

This contains 10 per cent, of opium. 

Wine of Opium; dose 5 to 15 minims. 

This is flavored with cinnamon and cloves. 

Acetum Opii (Black drop); dose, 5 to 15 minims. 

This is opium extract with dilute acetic acid. 

Mistura Glycyrrhizas Composita (Brown mixture); dose 
4 to 8 drams. 

This contains 1 part of opium in 1000 of the mixtuie. 
It consists of paregoric, licorice, wine of antimony, and 
spirits of nitrous ether. It is used to lessen cough. 

Compound Tincture of Opium (Squibb’s diarrhea mix¬ 
ture) ; dose 1 dram. 

This contains tincture of opium, tincture of capsicum, 
spirits of camphor, chloroform and alcohol. 

OPSONINS 

See Vaccines, Bacterial. 

OPTOCHIN 

See Ethylhydrocupreine. 

ORTHOFORM 

Orthoform is an artificial chemical substance formed by 
the combination of methyl alcohol and amidooxybenzoic acid. 


OSTEOMYELITIS 


It is used as a local anesthetic like cocaine, but since it is 
very slowly absorbed, it produces no general effects and no 
poisonous symptoms. It is not used hypodermically. It 
is used principally to relieve pain on a wounded surface 
and on mucous membranes. It is often used to relieve the 
pain of an ulcer in the stomach. 

Preparation 

Orthoform New; dose 8 to 15 grains. 

It is often applied on wounds in the form of a dusting 
powder or as an ointment. 

See Cocaine. 


OSTEOMYELITIS 

Osteomyelitis is an inflammation of the medulla or marrow 
of the bone. It may be acute or chronic, and generally 
results from a bacterial infection. All those compound frac¬ 
tures of the war. due to shrapnel and machine gun bullets, 
were complicated, as a rule, by osteomyelitis in varying 
degrees. 

Symptoms. —The symptoms may consist of great pain re¬ 
ferred to the bone affected, high fever, rapid pulse, and 
general malaise. There may be swelling, redness, and 
marked tenderness on pressure over the involved area. 

Treatment. —The treatment is operative. An attempt is 
made to give the bone free drainage by incision through the 
skin and muscles and then sufficient cortex of the bone is 
removed to permit the pus in the medulla to drain freely. 
To insure free drainage the wound is packed with gauze, and 
to clean up the infection the bone and wound are Dakinized. 
If the condition is complicated by fracture, the limb is 
treated by suspension and traction, plus the Dakin treatment. 

Because of the hardness and unyielding character of bone 
it will take a long while for the dead bone in the medulla to 
form a line of demarcation from the living, and that is why 
these cases of osteomyelitis linger so long before they are 
healed. The dead bone which often comes away in spicules 
at a dressing, or which is removed at some subsequent opera¬ 
tion, is spoken of as a sequestrum. 

Inasmuch as the majority of these cases will suffer for 
some time from a continual low grade toxemia, it is im¬ 
portant to look after their general condition. These pa¬ 
tients should be given as much fresh air as possible, kept 
on a high calorie diet, and, although confined to bed, the 
muscles of the affected limb should be given daily massage 
whenever possible. This will insure proper nourishment and 
maintain muscle tone, for it is well known that muscles not 
in active use are apt to undergo atrophy. The temperature 


OVARY 


should be carefully watched as any sudden rise might be 
indicative either of retention of pus somewhere in the 
wound, or the starting of a new focus in the same bone or 
another one. 


OVARIAN EXTRACT 

This is a powder made from the fresh ovaries of pigs. It 
is used to relieve the symptoms of the artificial menopause, 
such as flushes of the face and nervousness, which follow 
the complete removal of both ovaries. These symptoms re¬ 
sult from the absence of the internal secretion of the 
ovaries. 

Ovarian extract is given in doses i to 3 grains. 

OVARY 

The ovaries are two almond-shaped, glandular bodies, situ¬ 
ated one on each side of the uterus, in the posterior fold 
of the broad ligament, behind and below the Fallopian tubes. 
Each ovary is attached at its inner end to the uterus by a 
short ligament—the ligament of the ovary—and at its 
outer end to the Fallopian tube by one of the fringe-like 
processes of the fimbriated extremity. The ovaries each 
measure about one and a half inches in length, and weigh 
from one to two drams. 

The ovary besides secreting the ovum possesses an in¬ 
ternal secretion which exercises a very important part in 
maintaining the normal nervous mechanism of the individual. 
Removal of both ovaries results in the complete cessation of 
menstruation and a train of nervous symptoms which make 
these patients objects of pity. They become very excitable, 
nervous, melancholy, and often so desperate that they have 
ended their existence by suicide. It is now the custom, 
whenever possible, to leave some part of the ovarian tissue, 
and should it be absolutely necessary to remove all of it, 
as in radical panhysterectomies for cancer of the uterus, 
the patient may be fed ovarian extract. Good results often 
follow. 

Diseases of the Ovary. —Ovaritis is an inflammation of the 
ovary, rarely primarily diseased but usually secondary to 
tubal inflammation, which results in adhesions between 
both structures producing a condition spoken of as “dis¬ 
eased adnexa” or salpingo-oophoritis. The symptoms are 
similar to those of salpingitis and the treatment employed 
is the same. 

See Fallopian Tubes, Diseases of. 

New Growths.—Cysts. —More than any other organ, the 
evary is apt to give rise to cysts and cystic degeneration. 


OXALIC ACID 


The cysts may be of small size, or grow to enormous di¬ 
mensions weighing more than twenty pounds. They may be 
filled with a clear viscid fluid or with other cellular materials. 
Types of the last named variety are occasionally called cys- 
tadenomas. Certain of these tumors, if their contents are 
spilled over the peritoneal cavity, will cause secondary 
tumors acting much like malignant growths. 

Dermoid Cysts.—These are tumors which contain remnants 
of the epidermis, such as hair; in addition bone is often 
found as well as other tissues. 

Treatment of Cysts.—In the case of simple cysts, only 
part of the ovary affected may have to be removed, or if the 
entire ovary is filled with many small cysts, a complete 
oophorectomy may be performed. It is highly important 
that cysts of the ovary be delivered intact. Every effort 
should be made to preserve their integrity, for occasionally a 
cyst may be of the adenomatous variety, and if accidentally 
ruptured the fluid escapes into the general peritoneal cavity 
and implantation growths take root. 

In carcinoma of the ovary, the treatment, of course, is 
extirpation with subsequent X-ray or radium treatment. 
The general outlook for patients with ovarian carcinoma is 
indeed poor. 


OXALIC ACID 

Oxalic acid is an organic acid, found in sorrel and other 
vegetable substances. It is never used as a medicine, but 
potassium oxalate, or essential salt of lemon, and oxalic acid 
are frequently used to clean metal kitchen utensils. These 
salts resemble Epsom salts in appearance, and are a frequent 
cause of severe poisoning, when taken by mistake, or with 
suicidal intent. The symptoms are due to the removal of 
calcium from the blood and tissues, because the oxalic acid 
readily combines with it. 

Oxalic Acid Poisoning 

The symptoms usually appear in a few minutes: 

1. Severe burning pain in the mouth or throat. 

2. Intense cramp-like abdominal pain. 

3. Profuse vomiting, the vomited matter containing mucus, 
pieces of mucous membrane and blood. 

4. Muscular weakness and twitchings of the muscles. 

5. Occasionally convulsions. 

6. Collapse (rapid, irregular, weak, thready pulse, slow, 
shallow breathing, cyanosis, cold, moist skin, coma and 
death). 

The patient may die in a few minutes from collapse; or in 


OXYGEN 


a few weeks from starvation or from nephritis, as a result 
of the injury to the stomach, intestines and kidneys. One 
ounce of oxalic acid usually proves fatal; though death has 
occurred from as little as one dram. 

Treatment.—i. Neutralize the oxalic acid at once with an 
alkali, such as calcium. Lime-water, chalk or the plaster 
from the wall may be used for this purpose. 

Do not give any preparation of sodium or potassium, as 
these form poisonous substances with the oxalic acid. 

2. Give emetics. 

3. Protect the mucous membranes with egg albumen, 
milk, etc. 

4. The collapse is treated with heart stimulants, such as 
strychnine, caffeine, digitalis, etc. 

OXYGEN 

Oxygen is a gas which forms 20 per cent, of ordinary air, 
and is necessary for the life of all animals. It is inhaled 
by the lungs with the inspired air. From the lungs, it 
enters the blood and combines with the hemoglobin of the 
red blood cells. These cells carry the oxygen to the 
various tissues and organs of the body, where it combines 
with some of the constituents of their cells, and thus en¬ 
ables the organs to carry on their various activities. 

Local Action.—Oxygen is a very good antiseptic, since 
most bacteria are unable to live in an atmosphere of pure 
oxygen. 

Internal Action.—When pure oxygen gas is inhaled, it 
enters the plasma of the blood, from the air sacs of the 
lungs. Some of the oxygen combines with the hemoglobin, 
forming oxyhemoglobin, while part of it circulates uncom¬ 
bined, in the plasma. The formation of a greater amount 
of hemoglobin, gives the blood a brighter color, and the 
color of the skin then becomes more ruddy. 

The improved condition of the blood makes the breathing 
slower, and slows and strengthens the heart action. 

Uses 

Oxygen is used in pneumonia, when the patient is blue 
and cyanotic, as a result of inability to obtain enough 
oxygen in the blood, because part of the lung is consoli¬ 
dated. The oxygen inhalations often relieve this blue color, 
and make the breathing easier. 

Oxygen is also given in potassium chlorate, and in illu¬ 
minating gas poisoning. These drugs combine with the 
hemoglobin of the blood, and prevent it from taking up 
oxygen from the lungs. The oxygen given in such cases 


OXYGEN 


enters the plasma in sufficient quantity to supply the tis¬ 
sues with nourishment until the hemoglobin is freed from the 
poisonous substance. 


Administration 

Oxygen should always be given continuously, inhaled 
through a mask from a tank beside the bed. The inhala¬ 
tions should be stopped when the symptoms disappear. 


p 


PAINS 

See Labor, Management of. 

PANCREAS 

The pancreas is an elongated organ, of a pinkish color, 
which lies in front of the first and second lumbar vertebrae 
and behind the stomach. It weighs between two and three 
ounces, is about six inches long, two inches wide, and one- 
half inch thick. In shape it somewhat resembles a ham¬ 
mer, and is divided into head, body, and tail. The right 
end, or head, is thicker and fills the curve of the duodenum, 
to which it is firmly attached. The left, free end is the 
tail, and reaches to the spleen. The intervening portion is 
the body. 

The duct, about the size of a goose-quill, runs length¬ 
wise through the gland, from the tail to the head. The 
pancreatic and common bile duct usually enter by means of 
a common opening into the duodenum about three inches 
below the pylorus. Sometimes the pancreatic duct and 
the common bile duct open separately into the duodenum, 
and there is frequently an accessory duct which opens into 
the duodenum about an inch above the orifice of the main 
duct. 

Surgical Conditions of the Pancreas. —The operations upon 
the pancreas are very few in number. The only diseases 
which need demand our attention are pancreatitis, either 
in chronic or acute forms, and cancer of the head of the 
pancreas. In inflammatory diseases of the pancreas, inas¬ 
much as the bile is supposed to be an irritating and causative 
factor, its flow is short-circuited by draining the gall blad¬ 
der (cholecystostomy ). In the meanwhile the pancreas, free 
from the irritating effects of bile, will gain a much needed 
rest, and the inflammatory process may subside. 

Carcinoma of the head of the pancreas may encroach 
upon the opening of the bile duct in the second portion of 
the duodenum causing intense jaundice. Inasmuch as new 
growths of the pancreas cannot be excised without a terrific 


PANCREATIN 


operative mortality and disastrous after-results, the only 
operation done to relieve the unfortunate jaundice victims is 
that of drainage of the gall bladder. The nursing procedures 
employed in these cases are similar to those used in operations 
upon the gall bladder. 


PANCREATIN 

Pancreatin is a mixture of all the ferments obtained from 
the fresh pancreatic glands of the pig. It is used prin¬ 
cipally to predigest foods, before they are given to the 
patient, in cases where the patient himself is unable to 
digest food. 

Pancreatin can act only in the presence of an alkali, and 
must always be given with sodium bicarbonate. It is seldom 
given internally, as it is destroyed by the hydrochloric acid 
in the stomach. 

When it is given internally, it should be given in pills 
coated with keratin, a substance which the acid of the 
gastric juice does not affect, but which is dissolved by the 
alkaline intestinal juices. 

Pancreatin; dose 2 to 5 grains. 

PAPAVERINE 

Papaverine is one of the alkaloids obtained from opium. 
Papaverine acts like morphine only to a very slight degree. 
It relieves pain and lessens the activity of the brain only 
slightly, but it is somewhat of a local anesthetic. 

It lessens the contractions of all involuntary muscles, 
such as those of the stomach, the ureters, gall ducts, and 
intestines. 

It is therefore used to lessen the pains caused by the 
spasm of the involuntary muscles in ulcer of the stomach, 
gall stone colic, kidney colic, painful menstruation and pain¬ 
ful urination. It is also used to lower blood pressure and 
to lessen the convulsions in eclampsia. 

Papaverine does not induce a habit. 

Preparations 

Papaverine; dose y 2 to 1V4 grains. 

Papaverine Hydrochloride; dose y 2 to 1V4 grains. 

Papaverine Sulphate; dose y 2 to 1% grains. 

PAPERS 

Papers are small pieces of paper impregnated with medi¬ 
cinal substances. 


PARACENTESIS 

Paracentesis is tapping a cavity of the body for the 
purpose of evacuating fluid contained therein. 


PARAFORM 


Articles Required for Paracentesis 

1. Small blanket for shoulders. 

2. Board under springs, if patient is on edge of bed. 

3. Back rest and two or three extra pillows. 

4. Two chairs on which patient will rest her feet. 

5. One chair for operator. 

6. Large basin or pail to receive fluid. 

7. Sterile bottle, if fluid is to be examined. 

8. Laparotomy stockings. 

9. Abdominal binder and safety pins. 

10. Preparation tray, containing: 

(a) Liquid soap. 

(b) Bowl of hot water. 

(c) Razor. 

(d) Gauze sponges. 

11. Tray, containing: 

(a) Trocar and cannula, rubber tubing attached. 

(b) Scalpel. 

(c) Probe. 

(d) Scissors, 

(e) Artery clamp. 

(f) Suture needles and suture silk. 

(g) Forceps. 

(h) Package of sterile sponges. 

(i) Package of sterile towels. 

(j) Gauze dressing, adhesive plaster. 

(k) Local anesthetic. 

Procedure. —Draw up patient’s nightgown well above 
hips and pin securely in place with safety pins. Shave sur¬ 
rounding area, if necessary, and clean where puncture will 
be made, which is between umbilicus and pubes. Draw 
on laparotomy stockings and pin to nightgown on each side. 
Turn down upper bed clothes to foot of bed. Lift patient 
to side of bed and place in sitting position with feet on 
chairs and back supported by back rest on pillows. Cover 
shoulders with blanket. Place tray in convenient place 
for physician. Clean and disinfect hands, place sterile 
towel on each thigh, paint area with iodine. Assist operator 
as indicated. After removal of cannula, wound is dressed, 
patient returned to lying position, abdominal binder pinned 
on tightly. Dressing and binder will require changing 
later as fluid continues to exude. 

PARAFFIN, LIQUID 

See Liquid Petrolatum. 

PARAFORM 


See Formaldehyde. 


PARAFORMALDEHYDE 


PARAFORMALDEHYDE 

See Formaldehyde. 


PARALDEHYDE 

Paraldehyde is a colorless liquid having a peculiar, un¬ 
pleasant taste and odor. It is an oxidation product of 
alcohol. 

A few minutes after an average dose of paraldehyde is 
given, the patient becomes drowsy and soon falls asleep. 
The sleep resembles the natural sleep, and lasts from about 

S to 6 hours, but it is not as deep as that of chloral. The 

pulse and breathing are normal, and there are usually no 
after-effects when the patient awakes. The action of par¬ 
aldehyde is similar to that of chloral. 

It has a hot, burning taste; and it often causes nausea and 
occasionally vomiting. 

Paraldehyde is absorbed into the blood in a few minutes, 
through the mucous membrane of the stomach. After ab¬ 
sorption, it acts principally on the nervous system. It 
lessens all the activities of the brain, thereby producing 
sleep; all reflex action is lessened, so that the patient does 

not respond readily to external stimuli; it lowers the tem¬ 

perature by lessening the production of heat. 

Poisonous Effects 

Paraldehyde rarely, if ever, causes fatal symptoms. Over¬ 
doses often cause the following symptoms: 

1. Vomiting. 

2. Stupor. 

3. Slow, shallow breathing. 

4. Cyanosis. 

Prolonged use occasionally causes the following symptoms: 

1. Nausea, loss of appetite, and poor digestion. 

2. Ulcers in the nose. 

3. Various eruptions, principally areas of redness. 

Uses 

Paraldehyde is used principally to produce sleep and to 
lessen muscular activity in epilepsy and delirium tremens. 
In giving paraldehyde, it is important to disguise its taste, 
otherwise many patients cannot take it. It should be well 
diluted in water, brandy, syrup, or sweetened butter. It 
should be given a few minutes before bedtime. Dose, 16 
to 60 grains. 

Paraldehyde is frequently given by the rectum, especially 
in cases of delirium tremens. The best method is to dissolve 
the drug in boiled starch and then inject it into the rectum 
through a catheter. 

See Chloral. 


PARANOIA 


PARANOIA 

This is a form of mental disease which occurs usually in 
adult or middle life and is characterized by the gradual 
development of an unchangeable progressive system of 
delusions, without marked mental deterioration. 

The physical symptoms are those incident to worry, loss 
of sleep, etc. 

Mental symptoms. —The mind shows little impairment. 
Memory is correct, orientation is not disturbed and con¬ 
sciousness is clear. Oftentimes there are hallucinations of 
hearing in which voices are calling the patient bad names, 
slandering and plotting against him. The most outstanding 
symptoms are the delusions of persecution, which are per¬ 
sistent, unchangeable and systematized, and strongly de¬ 
fended when attacked. They are not always absurd; and 
although the ideas are false they are so skilfully combined 
and woven together that the resulting scheme may appear 
reasonable. The emotions are determined by the delusions. 
The personality gradually undergoes a change, for in order 
to satisfactorily explain his persecutions the patient begins 
to think he must be a very unusual and important person 
inasmuch as everything which transpires about him seems 
to refer directly to himself, and he finally believes he is a 
great personage. The conduct is orderly except for occa¬ 
sional assaults due to the delusions. An intense Hatred of 
individuals is oftentimes developed and fostered by the 
delusions, and the patient sometimes becomes very dan¬ 
gerous. 

Nursing procedures. —As these patients are irritable, 
suspicious and quarrelsome, constantly on the lookout for 
slights and evidences of unfriendliness, much tact is re¬ 
quired in caring for them. Whatever seems to irritate or 
annoy them should be removed in so far as possible, and 
references to whatever is known to be included in their 
delusions must be carefully avoided. They should be 
regularly occupied with some useful work in which they 
may be interested, and which of course does not conflict with 
their delusions. As the intellectual impairment is so slight 
they can many times be given work which carries some de¬ 
gree of responsibility and this always makes a specal appeal. 
The care of the library, cataloguing, bookbinding, book¬ 
keeping, story writing and translating, leather work, block 
printing, wood carving, carpentry, basketry, weaving, the 
study of languages or science, and the study of architec¬ 
ture are some of the ways in which they may be employed. 
Many enjoy books of science, history and biography; and 
music, dancing, all the various indoor and outdoor games, 
sports and diversions should be provided. Careful observation 


PARATOPHAN 


and supervision are required at all times to prevent acci¬ 
dents. 

PARATOPHAN 

See Atophan. 


PARATYPHOID FEVER 


Typhoid fever has two close relatives which nevertheless 
are quite distinct. These are known as Paratyphoid A and 
Paratyphoid B. They are due to germs much like the 
typhoid bacillus in many respects. They exhibit symptoms 
much like those of typhoid. The blood of a typhoid patient, 
which agglutinates typhoid bacilli, will agglutinate the para¬ 
typhoid bacilli also, if it is used in sufficient strength. 
Nevertheless, closely allied as they are, inoculation with 
dead typhoid fever germs, which protects the inoculated 
person against typhoid fever, does not protect against 
paratyphoid; and vice versa. Indeed, even the two para¬ 
typhoid diseases, A and B, are so distinct in this respect 
that the germ of each protects against itself but not against 
the other. 

Paratyphoid fever has about the same incubation period 
as typhoid fever, a more abrupt outset, a shorter course and 
a lower fatality. 

We know comparatively little about these diseases because 
they are in this country rather rare; they have not long 
been differentiated from typhoid fever, and being of less 
importance they have attracted less attention. They are 
usually overlooked or mistaken for mild typhoid unless 
laboratory tests are carefully made. The most conclusive 
of these is the testing of the blood for presence of the germ. 

See Typhoid Fever, and Infectious Diseases, Course 
of. 


PAREGORIC 

See Opium. 

PAROTITIS, EPIDEMIC 

See Mumps. 

PEARSON’S SOLUTION 

See Arsenic. 

PEDICULOSIS 

See Lice, and Skin Diseases. 

PELLETIERINE 

See Granatum. 



PELVIS 

Obstetricians divide the pelvis into two portions—the 
upper part or false pelvis, and the lower part or true pelvis. 
The False Pelvis is enclosed by the wings of the iliac 





PELVIS 


bones. It is of little moment in obstetrics, but when covered 
by the iliacus muscles it forms a cushion for the gravid 
uterus to rest upon, and also acts as a funnel to direct the 
head of the fetus into the brim of the true pelvis. It is of 
interest also in so far as its measurements bear a more or 
less constant relationship to those of the true pelvis. Of 
these measurements two are of importance. 

(1) The interspinous diameter is the distance from one 
anterior superior spine of the ilium to the other, and meas¬ 
ures 9^2 to io inches (23.75-25 cm.). 

(2) The intercristal diameter is the distance between the 
widest apart points on the iliac crests, and measures 10 J4 to 
11 inches (26.25-27.5). 

The inch of difference between these two measurements is 
the most important point, as it indicates a normal curvature 
of the iliac crests, a feature which is absent in the most 
common forms of contracted pelvis. The intercristal diam¬ 
eter is also approximately double the transverse diameter 
of the brim of the true pelvis. 

The intertrochanteric diameter is the distance from one 
great trochanter of the femur to the other, and measures 
about 12 inches (30 cm.). 

All these diameters may be measured clinically by means of 
a pelvimeter or large pair of callipers. 

The True Pelvis is the all-important part in obstetrics. 
For convenience in description it is usually divided into 
three parts—the brim, inlet, or superior strait; the cavity; 
and the outlet or inferior strait. 

The inlet of the pelvis is somewhat heart-shaped owing 
to the projection forwards of the promontory of the sacrum. 

The cavity is bounded above by the plane of the brim, and 
below by the planes of the outlet. In front it is bounded 
by the pubic bones, the front wall being thus about 1/2 to 2 
inches deep (3.75-5 cm.). The lateral walls are formed by 
the ischia anteriorly, and the sacro-sciatic ligaments pos¬ 
teriorly, and are midway between the front and back walls as 
regards depth. The back wall is formed by the sacrum 
and coccyx, is curved and long, measuring about 4/4 to 5 
inches (11.25-12.5 cm.) In shape the cavity is roughly cir¬ 
cular, and with the woman in the upright position it is at 
no horizontal level bounded entirely by bone. Owing to 
the curve of the sacrum the direction of the cavity alters as 
it passes down. The upper portion is directed downwards 
and backwards, and is straight as far as the junction of the 
second and third bodies of the sacrum. There it begins 
to curve forwards, and at the actual outlet is directed 
downwards and forwards. 

The outlet of the pelvis is lozenge-shaped. It is bounded 


PELVIS 


posteriorly by the coccyx and the sacro-sciatic ligaments, 
and anteriorly by the lower edge of the symphysis and the 
rami of the pubes. Laterally it is bounded by the tuber¬ 
osities of the ischia. 



(From Johnstone’s Textbook of Midwifery ) 

Diameters of the True Pelvis 

Brim.—(i) The antero-posterior diameter is measured from 
the center of the promontory of the sacrum to the top of the 
symphysis pubis. Owing to the rather elliptical shape of the 
brim and the fact that the shortest diameter of an ellipse is 
called the conjugate, this measurement is often spoken of as 
the conjugate diameter. Strictly speaking, there are two 
conjugates to be described, according as the measurement is 
taken to the summit of the symphysis or to the upper margin 
of the posterior surface. Owing to the beveled shape of the 

top of the symphysis there may be almost a quarter of an 

inch (0.6 cm.) difference between the two, and obviously 
this space is not available for the passage downwards of the 
head. The measurement to the very summit is therefore 

called the anatomical conjugate or conjugat a vera; while 

the diameter measured to the upper edge of the posterior sur¬ 
face is known as the obstetrical or the “available” conjugate. 
The former measures inches (10.6 cm.), the latter about 
4 inches (10 cm.). 

The right oblique diameter is measured from the right 
sacro-iliac joint to the left ilio-pectineal eminence. It meas¬ 
ures 4^2 inches (11.25 cm.). 

The left oblique diameter is measured from the left sacro¬ 
iliac joint to the right ilio-pectineal eminence. It measures 
4^2 inches (11.25 cm.). 

The transverse diameter is the greatest distance between 
the two ilio-pectineal lines. It measures 5 inches (12.5 cm.). 







PELVIS 


Cavity.—In the cavity at the level of the third sacral 
vertebra, and the middle of the posterior surface of the 
symphysis, all the diameters— antero-posterior, oblique, and 
transverse —measure about 4J4 inches (11.25 cm.). 



Diameters of the Outlet. 

(From Johnstone’s Textbook of Midwifery) 


Outlet.—The antero-posterior diameter is measured from 
the tip of the coccyx to the center of the under margin of 
the pubic symphysis. With the coccyx pointing forward it 
measures about 4 inches (10 cm.), but with the coccyx turned 
backwards as in labor it measures 5 inches (12.5 cm.). 

The transverse diameter is measured between the inner 
(medial) surfaces of the ischial tuberosities and is 4 inches 
(10 cm.). 

The diagonal conjugate diameter is the distance from the 
center of the promontory of the sacrum to the center of 
the under margin of the symphysis. It usually measures 
about inches (11.9 cm.), varying a little with the depth 

and the inclination of the symphysis. Subtraction of from 
y 2 to Y\ of an inch (1.2-1.9 cm.) from this measurement 
gives us the approximate size of the conjugate of the brim. 

The most important diameters of the true pelvis may be 
memorized conveniently from the followng table: 



Antero¬ 

posterior. 

In inches. 

Oblique. 

In inches. 

Transverse. 

In inches. 

Brim 

Cavity 

Outlet 

4 * (10 cm.) 

4 £ (11.25 cm.) 
5 § (12.5 cm.) 

4 J (11.25 cm.) 
4 j (11.25 cm.) 
4 .^ (11.25 cm.) 

5 (12.5 cm.) 

4 i 11.25 cm.) 

4 (10 cm.) 


* Obstetrical conjugate. § Coccyx turned back as in labor. 
















PENTAL 


This table shows at once two important facts: (i) that 
the pelvis diminishes in transverse measurement as we pass 
down; and (2) that while at the brim the longest diameter 
is the transverse, at the outlet it is the antero-posterior, and 
conversely. 

Characteristics of the Female Pelvis as Compared with the 

Male 

1. Bones lighter and smoother, and muscular attachments 
less marked. 

2. Iliac crests farther apart. Iliac fossae more hollowed. 

3. Sacrum broader. 

4. Promontory less pronounced. 

5. Symphysis less deep. 

6. Brim more oval, less heart-shaped. 

7. Inlet more capacious. 

8. Cavity shallower: less funnel-shaped: roomier. 

9. Outlet wider: ischial tuberosities farther apart. 

10. Pubic arch wider, 90° to ioo°—in male about 75 

11. Coccyx more movable. 

12. Acetabula farther apart. 

PENTAL 

See Anesthetics. 

PEPO (PUMPKIN SEED) 

Pepo is the ripe seed of Cucurbita pepo or the ordinary 
pumpkin. Its active principle is a fixed oil and a resin. 

Pumpkin seeds are a very efficient and harmless remedy 
for tape worms. 

Administration 

The patient should fast the day before the drug is to be 
given, and the following morning about two to four ounces 
of the seeds, beaten up in an emulsion of sugar and water, 
or honey, should be given. Occasionally, half an ounce of 
the expressed oil is given. It should always be followed by 
a cathartic several hours later. 

See Anthelmintics. 


PEPSIN 

Pepsin is a ferment obtained from the lining membrane 
of fresh stomachs of healthy pigs. It is used to aid di¬ 
gestion in cases where the pepsin of the gastric juice is 
diminished. 

Pepsin acts only in the presence of an acid; it should 
therefore always be given with dilute hydrochloric acid 
Alkalies destroy its activity; it should therefore never b< 
given with such substances as sodium bicarbonate. 

Dose of Pepsin 5 to 10 grains. 


PERNICIOUS VOMITING 


PEPTONIZED MILK 

See Milk. 

PERINEORRHAPHY 

The perineum is sometimes torn during childbirth. A peri¬ 
neorrhaphy is an operation in which the lacerated perineum 
is sutured. 

The after-treatment , like that of any other wound, is ex¬ 
tremely important. Its care is the responsibility of the nurse. 
All strain on sutures, whether due to restless movements or 
to straining at stool, must be avoided. Sometimes it is 
necessary to bandage the thighs together. The sutures must 
be kept scrupulously clean and free from infection. Some 
surgeons require the patient to be catheterized for the first 
three to five days to avoid contamination of the wound with 
urine. All dressings are carried out with strict aseptic 
precautions, as in treating an abdominal wound. After 
the use of the bedpan, the part is irrigated with boric acid 
solution and very gently sponged until quite clean. The 
parts are then dried gently. Dry sterile dressings are 
usually applied. Aristol (an antiseptic), or zinc oxide oint¬ 
ment is frequently used. Any symptoms of inflammation— 
soreness, redness, swelling—in the wound should be noted 
and reported. Hot moist antiseptic dressings may be 
ordered in such cases. Dressings are held in place with a 
T binder. 

When vaginal douches are ordered following a perine¬ 
orrhaphy, a soft rubber catheter or an irrigating tip instead 
of the usual douche nozzle should be used. The douche 
should coincide with one of the usual dressings so as not 
to disturb the wound more than is absolutely necessary. 

PERINEUM, CARE OF 

See Labor, Management of. 

PERITONSILLAR ABSCESS 

See Pharynx. 

PERNICIOUS VOMITING (POST OPERATIVE) 

This may occur in children as well as in adults, and is 
usually a manifestation of what is commonly spoken of as 
“acidosis,” a condition in which the normal alkalinity of the 
blood is diminished. It is recognized by the sweet and 
fruity odor of the breath. If this condition be suspected, 
the urine should be examined for the presence of acetone. 
If it be present, gastric lavage should be given, everything 
stopped by mouth, and alkalies administered immediately 
either by a ten per cent, sodium bicarbonate solution in a 


PETIT MAL 


Murphy drip, or intravenously in three to five per cent, 
solution, but never by clysis. 

Sodium bicarbonate is given until it is excreted by the 
kidneys. When the urine is alkaline it is safe to assume 
that sufficient bicarbonate has been administered to bring 
the blood back to its normal alkaline reaction, thus reducing 
the acidosis which is the underlying cause of vomiting in 
these particular cases. There is one point, however, which 
needs emphasis in the administration of sterile sodium bicar¬ 
bonate solutions. After the desired solution has been com¬ 
pounded, it must be sterilized. Sterilization, by its heat, 
drives off carbon dioxide, thereby reducing the bicarbonate of 
soda to sodium carbonate. This compound is not as good 
as the bicarbonate because it is more irritating to the tissues, 
and is not as effective in reestablishing the alkalinity of the 
blood. To counteract this, after the solution has been cooled 
sufficiently, carbon dioxide may again be added by connecting 
a sterile tube to a carbon dioxide tank and allowing the 
gas to bubble through the so^dium carbonate fluid for a 
sufficient length of time, thus' making a bicarbonate com- 
pound., 


PETIT MAL 

See Epilepsy. 

PETROLATUM, LIQUID 

See Liquid Petrolatum. 

PHARYNGITIS 

See Pharynx and Tonsils. 

PHARYNX AND TONSILS, DISEASES OF 

The pharynx is that cavity that is between the mouth, 
nose and esophagus. It is cone shaped and about five inches 
in length. In front and on each side are openings which 
communicate with the ears, nose, mouth and larynx. They 
are as follows: 

1. Posterior nares leading to the nose (2) 

2. Eustachian tubes leading to the ears (2) 

3. Fauces leading to the mouth (1) 

4. Opening into the larynx (1) 

5. Opening into the esophagus (1) 

The most common pharyngeal disorder is inflammation 
of the pharynx, known as pharyngitis. It is usually the 
result of infection spread from the nose, ears and mouth 
by the mucous membrane with which it is lined and which 
is continuous with the communicating passageways. It is 


PHARYNX AND TONSILS 


characterized by redness, swelling and some difficulty in 
swallowing. Relief can readily be obtained by external 
application of ice or cold compresses, and the use of gargles 
and sprays. 

Chronic pharyngitis occurs in smokers, those who habitu¬ 
ally inhale dust or irritating vapors and in alcoholics. 

On either side of the pharynx there are two almond-shaped 
bodies, the tonsils. They are situated between the anterior 
and posterior pillars of the fauces, and are composed of 
lymphoid tissue. Their exact function is not known, but 
they seem to be protective organs. Inflammation of the 
tonsils, or tonsillitis may be classed as: 

1. Acute 

2. Follicular 

3. Suppurative 

4. Chronic 

Tonsillitis usually occurs during youth, and may result 
from exposure to cold, wet, changeable climate, rheumatic 
diathesis, or acute exanthematous diseases. 

Acute tonsillitis is characterized by redness, swelling of the 
tonsils and adjacent tissues, pain, difficult swallowing, rise 
in temperature, chilliness and general malaise. 

Acute follicular tonsillitis differs from the above, in that 
the little depressions or crypts of the tonsils are the seat 
of tiny abscesses, and appears as white spots, one or many 
on each tonsil. It is caused by the streptococcus pyogenes; 
there is exti'eme pain on swallowing, rise in temperature, 
headache, very painful joints, loss of appetite and weight. 
An attack usually lasts about a week. 

Treatment for both of the above consists of: 

1. Cathartic, usually calomel in divided doses, followed 
by magnesium sulphate. 

2. Hot saline irrigations every one-half to one hour. 

3. Medicines such as salicylates, aspirin, etc. 

4. Rest in bed in a well-ventilated room. 

5. Nutritious liquid diet. 

Extreme care should be used in the sterilization of irri¬ 
gator tips and cans, as well as in the use of dishes and 
utensils. 

Suppurative tonsillitis, peritonsillar abscess, or quinsy. 

Whereas in follicular tonsillitis, the little abscesses open 
into the mouth, in the suppurative type they are underneath 
the tonsils so deeply that they cannot discharge externally, 
and may become so large as to push the tonsil to, or past, 
the mid-line ofr the throat. Pain and prostration in this 
condition are extreme. If allowed to go on it will rupture 
into the mouth, therefore it is better to lance early and thus 


PHARYNX AND TONSILS 

end the severe pain and prevent possible fatal results. After 
incising, the throat should be irrigated with antiseptic 
solution every hour or so to insure perfect drainage. 

Chronic tonsillitis, or chronically enlarged tonsils, are 
often found existing from birth, as the result of scarlet 
fever, diphtheria, acute tonsillitis, or as a part of a general 
enlargement of all the lymph tissue in the body. It must 
be remembered that the tonsils may not be painful, may 
not be red or swollen, but nevertheless, be the seat of a 
chronic infection, and a menace to the whole body. For 
to the germs they harbor, which are constantly entering the 
circulation, are due many attacks of acute articular rheuma¬ 
tism, chronic rheumatism, many cases of acute endocarditis, 
nephritis, many ear and eye troubles, and furthermore, they 
furnish a fertile field for the development of diphtheria 
and recurring attacks of follicular tonsillitis. It is being 
realized more and more that practically the only treatment 
for chronically enlarged tonsils is the removal of the same 
by tonsillectomy. 

Diphtheria is a disease primarily of the tonsils and 
pharynx but affecting the whole system. It is caused by 
the Klebs-Loeffler bacilli invading the throat, usually the 
tonsils, as they afford heat and moisture necessary to their 
multiplication. The bacilli remain at the site of local invasion, 
and give off toxins which, when absorbed, give rise to toxic 
symptoms. At first there is merely a hyperemia of the 
throat, but later a false—or pseudo—membrane is formed. 
This is at first gray, but soon becomes a brownish color. It 
cannot be readily taken off, and if removed leaves a raw, 
bleeding surface. Symptoms: sore throat, malaise, elevation 
of temperature, loss of appetite, headache, enlarged glands, 
difficult swallowing and breathing, and the presence of the 
membrane. 

Treatment: 

1. Isolation of the patient. 

2. Antitoxin. 

3. Rest in bed (very important because the heart is very 
susceptible to the poisons of diphtheria, and may become 
permanently damaged). 

4. Care to prevent spreading of the disease. 

Any case that looks like diphtheria should be quarantined 
and given antitoxin immediately. Quarantine is removed 
when all symptoms have disappeared and three successive 
throat cultures prove negative. 

Vincent’s angina is produced by the spirillum of Vincent. 
This spirillum, although ordinarily present in the mouth, 
occasionally becomes virulent and attacks the tonsils. It 
produces lesions covered by a white membrane which is 


PHARYNX AND TONSILS 


easily removed, but generally returns. There are headache, 
lassitude, severe pain, moderate rise in temperature, glandular 
enlargement, salivation, and very foul breath. Treatment of 
this condition varies, but may consist of: (i) painting area 
with saturated solution of gentian violet; (2) painting with 
iodine; (3) irrigation or gargles with solution of potassium 
chlorate, or small internal doses of potassium chlorate. 

Nursing care consists of: 

1. Rest in bed in a well-ventilated room. 

2. Nutritious liquid diet. 

3. Cathartics. 

4. Frequent gargles or sprays. 

5. Extreme care for prevention of spreading infectious 
material. 

Carcinoma of tonsils, although rare, may occur around 
the fortieth year. Treatment is removal of the tonsil. It is 
not very successful, for the deeper structures are usually 
involved. 

Chancre of tonsil, originating from careless use of knives, 
forks, glasses, dental instruments, etc. There is a sore 
throat of gradual onset. The chancre appears on the tonsil 
about one-fourth inch deep, with well cut edges, surrounding 
tissue indurated, very little pain, marked glandular enlarge¬ 
ment in the neck, and Wasserman reaction. Treatment is 
anti-syphilitic. Great precautions must be taken to prevent 
infecting others. 

Tonsillectomy prevents diseases of the tonsils. There are 
two methods of doing it. 

1. Under general anesthetic. 

2. Under local anesthetic. 

Persons over fifteen should have local anesthetic, for 
otherwise they are apt to get abscess of lung from blood 
getting into the trachea. 

Pre-operative precautions are: 

1. Specimen of urine to laboratory. 

2. Coagulation test. 

3. Physical examination. 

4. History of case. 

Post-operative treatment and care: 

1. Patient to be carefully watched. 

2. Report immediately any undue hemorrhage or vomiting 
of blood. 

3. Keep blood out of mouth. 

4. Water to drink when nausea ceases. 

5. Put patient in any comfortable position. 

6. Liquid diet one day, then soft diet with care. 

7. Ice collar to neck, if desired. 


PHENACETIN 


8. Cathartic following morning, and patient can be up 
and around. 

In case of post-operative hemorrhage: 

1. Call doctor at once. 

2. Apply ice to throat. 

3. Keep absolutely quiet. 

PHENACETIN 

See Acetphenetidin. 

PHENOCOLL 

Phenocoll is an artificial chemical substance which acts 
like phenacetin, but is said to be safer. It has been used 
as a substitute for quinine, in malaria. 

Preparations 

Phenocoll Hydrochloride; dose 5 to 20 grains. 

Phenocoll Salicylate; dose 15 to 30 grains. 

This combines the effect of phenocoll with salicylic acid, 
and is used to relieve rheumatic pains. 

Salocoll; dose 8 to 15 grains. 

See Antipyretics. 

PHENOL 

See Carbolic Acid. 

PHENOLPHTHALEIN 

Phenolphthalein is a chemical substance made from car¬ 
bolic acid, phthalic anhydride and sulphuric acid. 

It is used in the laboratory to test the reaction of various 
substances, since it turns red when an alkali is added to it. 

Phenolphthalein acts as a very good purgative, producing 
frequent soft stools with little griping. It acts on the 
large intestine, increasing peristalsis and preventing absorp¬ 
tion of fluids, thus causing bowel movements. Dose 2 to 3 
grains. 

PHLEBITIS (POSTOPERATIVE) 

This condition is an inflammation of the veins, usually 
of the lower extremity. It is rather late in onset and is 
annoying because the patient is confined to bed for a longer 
period of time. It is manifested by cramp-like pains in 
the leg, a rise in temperature, and a feeling of general 
malaise. Examination of the affected extremity shows that the 
part is swollen and the skin over the veins reddened. Occa¬ 
sionally the veins may be palpated. The treatment calls for 
absolute rest, elevation of the affected part and immobiliza¬ 
tion, the part being kept warm by a wrapping of cotton, or 
the additional heat of an electric pad. Phlebitis may be 
associated with, or followed by thrombosis. 


PHLEGMASIA ALBA DOLENS 


PHLEGMASIA ALBA DOLENS 

Synonyms are White Leg—Septic Thrombophlebitis.— 

Two separate pathological conditions, which are sometimes 
combined, are included under this term. 

(1) The thrombotic form of phlegmasia is a septic thrombo¬ 
phlebitis of the femoral or other veins of the lower limb. 
This is usually continuous with a similar process in the 
uterine veins, but it may be independent. The phlebitis and 
thrombosis tend to spread down the limb, and the venous 
return is obstructed, with the result that the whole lower 
limb from the foot up becomes markedly edematous. The 
veins of the upper limbs are occasionally, but rarely, affected 
in the same way. The swollen limb pits on pressure, and 
in thin patients the affected veins may be felt as tender 
cords. 

(2) The lymphatic or cellulitic form is really a deep 

cellulitis, usually but not invariably continuous with a para¬ 
metritis. The glands in the groin are frequently enlarged 
and tender. The swelling becomes very tense and hard, and 
soon ceases to pit on pressure, while the skin becomes 

white and glossy. If the skin is pricked the fluid that 

exudes is* coagulable lymph, not the simple serum of the 

thrombotic edema. 

Etiology. —The lymphatic form—the true “white leg”—is 
certainly septic in origin. It is rare now since the introduc¬ 
tion of antiseptic methods. The thrombotic form is probably 
also septic in origin in most cases, the phlebitis being 
secondary to the infection of the thrombus. But the 

condition of the blood is an important element, for the 
disease is much commoner after serious hemorrhages during 
labor, and in anemic women. 

Frequency. —About 1 in 400. The thrombotic form is 
much the commoner. 

Symptoms. —The left leg is more commonly affected than 
the right. This is probably because cervical tears are more 
common on that side, but the presence of the rectum may 
also tend to cause thrombosis on that side more easily. 

In most cases the early days of the puerperium have 
not been quite free of some slight feverishness. About the 
middle or end of the second week—often the tenth day— 
the temperature rises abruptly. There may be a slight rigor. 
Pain is felt in the affected limb, either in the thigh, calf, or 
ankle. The veins may be found tender to the touch. 

Swelling of the limb begins in the foot and spreads 
upward. In the thrombotic form it always pits on pressure, 
never attaining the tense, brawny hardness of the real 
“white leg.” Several days after the first onset the second 
leg is sometimes affected. 


PHLORIDZIN 


Under treatment the fever and pain last for a few days, 
and then gradually subside. Usually the veins regain their 
patency, and the swelling of the limbs gradually disappears 
in the course of several weeks. In the lymphatic form the 
swelling takes longer to disappear, and some swelling may 
persist for months, or even years. 

Treatment. —This is almost entirely symptomatic. Move¬ 
ment of the limb must be prevented, partly to diminish the 
pain, but more particularly to prevent the detachment of any 
portion of clot with its possibilities of consequent disaster. 
The limb should be raised on one or two pillows, or slung 
in a cradle, and movement prevented by sandbags. The 
pain may be relieved by hot fomentations of lead and 
opium, or x in 80 carbolic lotion. When not being fomented, 
the limb should be wrapped in cottonwool. Even after the 
acute symptoms have passed off, voluntary movement should 
be avoided until the swelling has to a great extent disap¬ 
peared. In the late stages, when all risk of embolism has 
ceased, gentle massage is helpful. 

PHLORIDZIN 

Phloridzin is a glucoside obtained from the rodts of the 
apple, pear, cherry, and other trees. 

It is occasionally used to destroy malarial parasites. It 
forms sugar in the urine and increases its secretion. Be¬ 
cause of its irritating effect on the kidneys, it is rarely 
used, except to test the action of the kidneys. Dose 5 to 10 
grains. 


PHOSPHORUS 

Phosphorus is a non-metallic element obtained from bones 
by the action of sulphuric acid and water. It is a semi¬ 
solid, soft, wax-like, colorless or yellowish substance, which 
emits light in the dark, and has an odor of garlic. 

Phosphorus is found in the body in many tissues, especially 
in nerve and bone tissue. In nerve tissue, phosphorus is 
present in large quantities combined with fats. These 
substances are called lecithins, or phosphorized fats. In 
the bones, phosphorus is combined with calcium, sodium, 
or magnesium. Phosphorus is also contained in many vege¬ 
tables. 

Action 

1. The principal effect of phosphorus is to increase the 
growth of bone. 

2. It slightly increases the formation of red blood cells 
but it does not increase the hemoglobin. 

3. It is said to improve the nutrition of nerve tissue by 


PHOSPHORUS 


supplying them with their necessary phosphorus. The 
hypophosphites and glycerophosphates are the preparations 
used. 

Poisonous Effects 

Phosphorus poisoning occurs in two forms: acute poison¬ 
ing and chronic poisoning. 

Acute Phosphorus Poisoning 

Acute phosphorus poisoning usually results from phos¬ 
phorus taken with suicidal intent. Many pastes used to 
destroy vermin, or match heads which contain phosphorus, 
are the substances usually taken. 

Symptoms. —The following are the characteristic symptoms 
which appear in about three to twelve hours. If an oily 
solution, or a paste is taken, they appear more rapidly; if 
the preparation is a solid one, they appear later. 

1. Abdominal pain. 

2. Nausea, vomiting and diarrhea. 

3. The vomitus and stools, as well as the urine, emit 
light when held in the dark and have an odor of garlic. 

4. Jaundice. 

5. Collapse and coma. 

Death from phosphorus poisoning has resulted from Y\ to 
2 grains. It has occurred in a few hours to a few weeks. 

Treatment.— 1. Old common crude turpentine, or French 
acid turpentine, about half a dram every fifteen minutes 
is given as an antidote. This forms a hard, solid mass with 
the phosphorus, and prevents its absorption. 

2. Occasionally hydrogen peroxide, or potassium perman¬ 
ganate, may be given to oxidize the phosphorus. 

3. Copper sulphate may be given to produce vomiting. 
It is also an antidote, and is best given in two grain doses 
every five minutes, until vomiting is produced. After that 
half a grain may be given every twenty minutes as long 
as ordered. 

4. Wash out the stomach. 

5. Give cathartics, especially salines such as hydrated 
magnesia. 

6. Protect the mucous membrane with albuminous drinks 
as the white of egg, etc. 

7. Do not give oils or fats, as these hasten the absorption 
of the phosphorus. 

8. The collapse is treated with stimulants. 

Chronic Phosphorus Poisoning 

Chronic phosphorus poisoning usually occurs as a result 
of continually inhaling the phosphorus fumes, in individuals 
who work in phosphorus match factories. It occurs most 


PHOSPHORUS 


frequently from the use of the yellow phosphorus, which has 
now mostly been given up, and the symptoms are therefore 
now rarely seen. 

Symptoms. —The symptoms usually begin with a carious 
tooth, or a sore gum. The gums become swollen and painful, 
abscesses of the jaw often form, with destruction of pieces 
of the jaw bone. Occasionally there may be slight jaundice, 
anemia, diarrhea, albumin in the urine, etc. 

Treatment.—Thorough ventilation of the factories where 
phosphorus is used, to get rid of the fumes, and the. 
inhalation of the crude turpentine, usually prevent the 
condition. 

When abscesses of the jaw form, they must be treated 
surgically. 

Uses 

Phosphorus preparations are used in the following con¬ 
ditions: 

x. In nervous diseases, such as neurasthenia, and other 
similar diseases, as a nerve tonic. 

2. To harden the bones in rickets, osteomalacia, etc. 

3. To increase sexual activity. 

Preparations 

Phosphorus; dose Vioo to VoO of a grain. 

Pills of Phosphorus. Each pill contains Vioo of a grain 
of phosphorus. 

Phosphorated oil; dose x to 5 minims. 

This contains about 1 per cent, of phosphorus in almond oil 
and ether, and is occasionally used. 

The following preparations are made from phosphoric 
acid, which is formed when phosphorus is burned. 

Dilute Phosphoric Acid; dose 5 to 15 minims. 

This contains 10 per cent, of the pure phosphoric acid. 

From the phosphoric acid the following salts are obtained: 

Precipitated Calcium Phosphate. 

This is rarely given alone, but in the form of an emulsion 
of cod liver oil and lactophosphate of calcium. Each dram 
contains 2 grains of calcium phosphate and half a dram of 
cod liver oil. 

Zinc Phosphide; dose V20 to V& of a grain. 

The following preparations are made from hypophosphorous 
acid: 

Calcium Hypophosphite; dose 15 to 30 grains. 

Iron Hypophosphite; dose 15 to 30 grains. 

Potassium Hypophosphite; dose 15 to 30 grains. 

Sodium Hypophosphite; dose 15 to 30 grains. 

Syrup of Hypophosphites; dose 1 to 2 drams. 


PHYSOSTIGMA 


This contains the hypophosphite of calcium, sodium and 
potassium, also the tincture of lemon peel and sugar. 

Compound Syrup of Hypophosphites; dose i to 2 drams. 

This contains iron hypophosphite in addition to the 
ingredients in the syrup of hypophosphites. 

The following preparation is made from glycerophos- 
phoric acid: 

Calcium Glycerophosphate; dose 3 to 10 grains. 

Various syrups and wines of glycerophosphates are on the 
market. Many of them are combined with iron. They are 
all good tonics. 

PHYSOSTIGMA AND ESERINE 

Physostigma is obtained from the Physostigmine veneno- 
sum, the calabar bean, or ordeal bean. 

Its active principle is an alkaloid, eserine, or physostig¬ 
mine. 

Appearance of the Patient 

About fifteen minutes after giving a dose of eserine, the 
patient usualy complains of cramp-like pains in the abdomen 
and slight weakness. He often feels somewhat nauseated and 
the bowels move very freely, the stools being quite fluid. 
There is usually a profuse secretion of saliva and perspira¬ 
tion. 

The pulse is slow and weak, and the breathing is at first 
somewhat rapid and deep, but later it becomes slow and 
shallow. The pupils are contracted, and the patient is 
unable to see distant objects clearly. He usually complains 
of weakness. 

Action 

The action of physostigma is due to the eserine which it 
contains. This is the preparation commonly used. The 
effects of eserine are quite similar to those of pilocarpine. 
They are due to stimulation of the nerve endings. 

Local action: Applied to the skin, or mucous membranes, 

it produces no effects, but the drug is readily absorbed from 
mucous membranes. 

Internal Action.—In the mouth: No effects are produced. 

In the stomach and intestines: It markedly increases the 
secretions of the mucous membranes and the peristalsis, 
much more so than pilocarpine does. Cramp-like abdominal 
pains with frequent fluid stools result. 

Action after Absorption.—Action on the involuntary 
muscles: Eserine increases the contractions of all the in¬ 

voluntary muscles, by increasing the activity of the nerve 
endings in the muscle wall. 

The muscles of the intestines are particularly affected, 


PHYSOSTIGMA 


the peristalsis is very much increased, and frequent fluid 
movements of the bowels result. The contractions of the 
muscles of the ureter, bladder and uterus are also increased. 

Action on the pupils: It contracts the pupil if applied 
locally to the conjunctiva, or when given internally. Eserine 
also contracts the ciliary muscle of the eye, a muscle which 
holds the lens in place. The contraction of this muscle makes 
the lens more convex, so that the patient is unable to see 
distant objects clearly. It also causes a free circulation 
of fluid from the posterior to the anterior chamber of the 
eye, thereby making the eyeball softer. Eserine is often 
used to produce this effect in glaucoma, a disease in which 
the eyeball becomes hardened, and which often results in 
blindness. 

Action on the secretory glands: Eserine increases the 
secretion of all the secretory glands, by making their 

nerve endings more sensitive to receive impulses for secre¬ 
tion. 

On the heart: eserine makes the heart heat slower, by 

making the nerve endings of the vagus nerves in the heart 
more sensitive to receive impulses for slowing the heart. 

On the blood vessels: The contraction of the involun¬ 
tary muscle fibers in the walls of the blood vessels makes 
the blood vessels narrower. The blood pressure is thus 
raised; usually, however, this effect is not very marked. 
The pulse of eserine is therefore slow and strong. 

Action on the respiration: The breathing is at first rapid 
and deep; later, it becomes slow and shallow. 

Action on the spinal cord: It lessens the reflex action 
of the spinal cord and medulla. 

Excretion 

Eserine is very rapidly eliminated from the body by the 
urine and by all the secretions. It begins to be excreted in 
a few minutes, and is entirely eliminated in a few hours. 

Poisonous Effects 

Since eserine is very rapidly excreted, only acute poison¬ 
ing occurs; usually from an overdose of the drug, given hypo¬ 
dermically or dropped into the eye. 

Symptoms. —i. Abdominal cramps. 

2. Nausea and vomiting. 

3. Diarrhea, with frequent watery stools. 

4. Excessive flow of saliva and perspiration. 

5. Rapid, then slow, shallow, difficult breathing. 

6. Slow, irregular, weak pulse. 

7. Contracted pupils. 

8. Twitchings of the muscles, beginning in the legs and 


PILLS 


extending to the upper extremities, with great muscular 
weakness. 

9. Collapse. 

Treatment. —1. Wash out the stomach. 

2. Keep the patient warm. 

3. Give artificial respiration. 

4. Atropine is given hypodermically. This is the antidote, 
as it paralyzes the overacting nerve endings, and increases 
the breathing. 

5. The collapse is usually treated with heart stimulants. 

Uses 

Eserine is principally used in the following conditions: 

1. To soften the eyeball in glaucoma, and to contract the 
pupil. 

2. To increase the peristalsis, to cause frequent move¬ 
ments of the bowels, and to expel gas. It is frequently 
used for the latter effect, on patients that have just been 
operated upon, and who have difficulty in passing gas; 
especially after gynecological operations. It should be 
avoided when the operation has been performed upon the 
stomach or intestines. 

3. It is occasionally used in chronic constipation. 

Preparations 

Extract of Physostigma; dose V 4 to 1 grain. 

Tincture of Physostigma; dose 15 to 45 minims. 

Eserine Salicylate (Physostigminae Salicylas) ; dose ^0 
to V20 of a grain. 

Eserine Sulphate (Physostigminae Sulphas) ; dose Vqo to 
t/20 of a grain. 


PICRIC ACID 

Picric acid is a yellow crystalline powder. 

When applied locally it checks the growth of bacteria 
(antiseptic) and contracts the skin and mucous membranes. 
It is used in the form of wet dressings on burns and other 
wounds and occasionally as douches. It is often applied in 
the form of an ointment. 

In large doses it is absorbed from the skin and causes 
the following poisonous symptoms: a yellow color of the 
skin and mucous membranes; the urine is also intensely 
yellow in color. It occasionally causes convulsions and 
collapse. 


PILLS 

Pills are drugs molded in the form of a very small 
sphere. They should always be fresh, for when they are 
exposed to the air they may become so hard that they 


PILOCARPINE 


cannot be dissolved by the juices of the stomach or intestines, 
and will then produce no effects. 

And see Cathartic Pills. 

PILOCARPINE 

See Pilocarpus. 

PILOCARPUS (JABORANDI) 

Pilocarpus or jaborandi is obtained from the leaves of the 
Pilocarpus jaborandi, or Pilocarpus microphyllus, a Bra¬ 
zilian shrub. Its active principle is an alkaloid, pilocarpine. 
The preparations of pilocarpine, the alkaloid, are principally 
used. 

Appearance of the Patient 

About five to fifteen minutes after a dose of pilocarpine 
is given, the patient sweats profusely, there is a profuse 
flow of saliva, of tears, and of mucus from the nose, mouth 
and bronchi. The face is flushed, the pupils are contracted, 
and there is difficulty in seeing distant objects. The breath¬ 
ing is faster, and the pulse is somewhat more rapid and 
weaker. Later there may be diarrhea. v 

Local action: Applied to the skin, pilocarpine produces 
no effects, but it is readily absorbed from such local applica¬ 
tions. It frequently increases the growth of hair on the 
scalp, whether it is applied locally or given internally. This 
is probably due to the increase in the secretions of the scalp. 
The hair is usually lighter in color and grows in patches. 

Internal action.—In the mouth: Pilocarpine has a bitter 
taste. 

In the stomach: It increases the secretion of the mucous 
membrane, and greatly increases the peristalsis of the 
stomach. In large doses it often causes nausea and vomiting. 

In the intestines: Pilocarpine increases the secretion of 
the mucous membrane and the peristaltic contractions of the 
muscle wall. Frequent movements of the bowels therefore 
often result. 

Dangers in the Use of Pilocarpine 

Pilocarpine is a very efficient drug; but its use is limited 
by some of the following effects, which are often injurious 
to the patient: 

1. The slow and weak pulse. 

2. The profuse secretion of mucus in the bronchi fills 
up the lungs with mucus, and the contractions of the in¬ 
voluntary muscles of bronchi make them narrower. The 
mucus is then expelled with difficulty, and the lungs fill 
up with fluid. This condition is known as edema of the lungs. 
The patient is then said to “drown” in his own sweat. 


PIPERAZINE 


3. Patients often feel very weak and chilly after pilo¬ 
carpine. 

Poisonous Effects 

Since pilocarpine is rapidly excreted, only acute poisoning 
occurs, usually from an overdose. 

Symptoms.— 1. Great weakness. 

2. Profuse secretion of saliva. 

3. Profuse perspiration and flow of tears. 

4. Occasionally, nausea, vomiting, abdominal pain and 
profuse diarrhea, with watery stools. 

5. Slow, irregular, weak pulse. 

6. Rapid, difficult breathing, accompanied by “rales.” 

7. Contracted pupils. 

8. Occasionally, dizziness, slight delirium, and twitchings 
of the muscles. 

The breathing finally becomes slow and shallow, the 
patient complains of great weakness, and death results from 
failure of the respiration. Consciousness remains to the end. 

Treatment. —1. Atropine is given as an antidote. This 
paralyzes the nerve endings, which have been made more 
active by pilocarpine, and neutralizes its effects. 

2. Give artificial respiration if the breathing is slow and 
shallow. 

3. Heart stimulants such as caffeine or camphor are 
usually given. 

Uses 

1. Pilocarpine is used principally to increase the sweat; 
in cases of nephritis, when the patient secretes very little 
urine, and to remove fluid from the tissues. To avoid 
unpleasant effects from pilocarpine, the patient should be 
wrapped up in blankets and kept warm. 

2. It is often used as a hair tonic, by local applications. 

3. It is often given to overcome dizziness resulting from 
lessened secretion in the labyrinth of the ear. 

Preparations 

Fluidextract of Pilocarpus; dose 8 to 30 minims. 

Pilocarpine Hydrochloride; dose to % of a grain. 

Pilocarpine Nitrate; dose Y20 to V2 of a grain. 

PINKROOT 

See Spigelia. 

PIPERAZINE 

Piperazine is a chemical substance which is frequently 
used to relieve gout, and to dissolve stones in the kidney 
and bladder. Its use is based upon the fact that it dissolves 
uric acid crystals, when added to them in a test tube. 


PIPSISSEWA 


Practical experience in the use of this drug has not borne 
out this effect on the patient. It slightly increases the flow 
of urine, however. 

Preparations 

Piperazine; dose 5 to 10 grains. 

Sidonal or Piperazine Quinnate; dose 15 to 20 grains. 

PIPSISSEWA 

See Chimaphila. 

PITCH 

See Tar. 

PITUITARY EXTRACT (PITUITRIN) 

Pituitary extract is a substance made from the pituitary 
gland of the ox. 

The posterior lobe of this gland secretes a substance into 
the blood which contracts the blood vessels and the uterus. 

Disturbed secretion of this lobe produces a peculiar group 
of symptoms, such as the change in some of the sexual 
characteristics of the individual. (Hypopituitarism.) 

Disturbed secretion of the anterior lobe causes enlarge¬ 
ments of the hands and features, a condition known as 
acromegaly. 

The following are the principal effects of pituitary extract; 
they are similar to those of epinephrin. 

1. Pituitary extract makes the heart beat slower and 
stronger by directly affecting the heart muscle. 

2. It makes the blood vessels narrower by contracting 
the small muscle fibers in their walls. It therefore greatly 
increases the blood pressure. This effect appears slowly 
but is more prolonged than that of epinephrin. The blood 
vessels of the kidney are the only ones that are dilated. 

3. It increases the contractions of the uterus. 

It is used to check bleeding from the uterus and to cause 
uterine contractions after labor. 

Preparations 

Desiccated Pituitary Substance (anterior lobe; dose 1 
to 5 grams. 

This is used in the treatment of acromegaly. 

Desiccated Pituitary gland (posterior lobe); dose 1 to 
5 grains. 

This is used in the treatment of hypopituitarism. 

Pituitary Body Desiccated; dose 1 to 5 grains. 

Pituitary Extract; dose 5 to 15 minims. 

Pituitrin; dose 5 to 15 minims. 


PLACENTA 


These substances are used to increase uterine contractions 
and to increase the blood pressure. 

See Epinephrin. 

PITUITARY GLAND, DISEASES OF 

The pituitary gland is composed of an anterior and 
posterior lobe. It rests in the sella turcica of the sphenoid 
bone. The function of the pituitary gland is probably 
concerned with growth. Too much secretion or hyper¬ 
pituitarism is a condition, which, if it occurs before the 
ossification of the epiphyses, leads to gigantism, and, when 
it occurs later, after the bones have become full grown, is 
responsible for acromegaly. Too little secretion of the 
pituitary body ( hypopituitarism ) in a growing child leads to 
increased fat deposition in the tissues, dwarfism, and poor 
development of the sexual organs. When this occurs in 
the adult it leads to adiposity and sexual retrogression. 

Probably the cases which interest us most from the surgical 
standpoint are those in which the pituitary gland is enlarged, 
with the result that the patient complains of severe head¬ 
aches, and a beginning blindness. This is often seen in 
the late stages of acromegaly, a condition in which there is a 
progressive increase in the size of the hands, feet, head, jaw, 
and the tissues about the face. 

Treatment. —Surgery endeavors to remove part of the 
pituitary gland. This may be done either by removing part 
of the body of the sphenoid bone via the nasal route, or by 
the subtemporal path. There is no special nursing entailed. 

PITUITRIN 

See Pituitary Extract. 

PIX LIQUIDA 

See Tar. 

PLACENTA 

The placenta at term is a roundish, fiat organ, about nine 
inches in diameter, and three-quarters of an inch in thick¬ 
ness at the center. It becomes thinner at the edges where 
it passes with direct continuity into the chorion laeve. The 
umbilical cord is usually inserted towards, but rarely exactly 
at, the center of the fetal surface. This surface is covered 
with amnion, a smboth, shining membrane that can be 
stripped off up to the insertion of the umbilical cord. Below 
it is the somewhat roughened surface of the chorion, with 
the branches of the umbilical vessels. The maternal surface 
is dark and fleshy in appearance, and divided into several 
“cotyledons.” The placenta generally weighs about one- 


PLACENTA 


sixth of the bodyweight of the fetus—usually a little over a 
pound. 

PLACENTA, DELIVERY OF 

See Labor. Management of. 

PLACENTA PREVIA 

A Placenta Praevia is one which is situated either in 
whole or in part upon the lower uterine segment. A placenta 
that completely covers the internal os is called a central 
placenta praevia; one whose edge partly overlaps the os is 



Normal and Morbid Situa- Morbid Situations 

tions of the Placenta. Placenta. 

(From Johnstone’s Textbook of Midwifery) 


of 


the 


distinguished as a partial or lateral placenta praevia; while one 
that is situated mostly on the upper uterine segment, but 
overlaps at its lower edge into the lower uterine segment, 
is called a marginal placenta praevia. 

Placenta praevia is most commonly found in multiparae, 
and frequently there is a history of previous endometritis. 

A placenta praevia is but rarely normal in other respects. 
It is usually larger than normal, and thinner, and the cord 
is often inserted abnormally. 

Frequency. —Happily the condition is rare. Among hos¬ 
pital patients its frequency is about i in 250, but in private 
practice it falls to 1 in 1000. The marginal variety is the 
commonest, the central the rarest. 


Margin^ 









PLACENTA PREVIA 


Symptom. —The one and only symptom is hemorrhage, 
which conies on with no apparent cause. It is rare for this 
bleeding to occur before the seventh month of pregnancy, 
but thereafter its frequency increases as the gestation pro¬ 
ceeds. The severity of the bleeding varies greatly. In 
some cases the first onset may be so serious as to endanger 
the patient’s life. More often the first hemorrhage is slight, 
and ceases spontaneously, but is followed by recurrence 
after several hours or days. The hemorrhage may come 
on at any time, during sleep for example, and is in most 
cases not connected with any exertion or trauma. 

The presence of the placenta in the lower pole of the 
uterus is associated with a tendency to malpresentation. 
Pelvic presentations, and more particularly transverse lies 
of the fetus, are considerably more frequent. 

The occurrence of the hemorrhage is usually followed by 
the onset of labor. The labor is thus in many cases prema¬ 
ture, a fact which accounts to some extent for the high fetal 
mortality. 

Diagnosis.—Every hemorrhage occurring in the last three 
months of pregnancy is to be regarded as probably due to 
a placenta praevia until and unless that condition can be 
excluded. The exact diagnosis is made by feeling the 
placenta. In the majority of cases the os is sufficiently 
open to allow one or even two fingers to be introduced, 
and the soft mass of the placenta can be felt. In lateral 
placenta praevia the edge of the organ may be felt, and 
the finger even passed over it so as to feel the vessels 
worming their way over the fetal surface. The placenta may 
be distinguished from a blood-clot by the fact that a clot 
is easily broken up by the fingers, while the placental sub¬ 
stance is more solid. At the same time the cervix is 
softer than usual, and there is an increased pulsation in 
the fornices, indicating greater vascularity. The presenting 
part is not easily felt, the boggy mass of the placenta inter¬ 
vening between it and the finger. 

Treatment. —The aims of treatment are to control hemor¬ 
rhage, and promote delivery. 

Palliation should not be attempted unless the patient is 
in a position to be constantly watched, and instantly treated 
when the bleeding recurs. 

Active treatment varies according to the condition of the 
cervix, and may conveniently be taken up in three divisions: 

(1) When the os is closed. 

(2) When the os admitr two fingers. 

(3) When the os is fully (or almost fully) dilated. 

When the os is closed. —This, fortunately, is but rarely 

the case. When it does occur, the best treatment is to 


PLACENTA PREVIA 


pack the vagina and apply a binder and perineal bandage. 
The pressure of the packing compresses the placental site 
against the placenta, and so controls bleeding, while at the 
same time the uterus is reflexly stimulated to contractions 
which lead to dilatation of the os. The objection to vaginal 
packing is that it causes an accumulation of blood and 
secretions behind the pack, and these are apt to be infected 
unless strict asepsis is observed. The pack should therefore 
never be left in a moment longer than is absolutely necessary. 
On its removal one hopes to find the cervix sufficiently 
dilated to admit two or more fingers. 

When the os admits two fingers (either as the result of 
previous packing, or when first examined).—In the majority 
of cases of hemorrhage the cervix is found so dilatable that 
two fingers can be passed through it. In these circumstances 
there are two methods of treatment open—either podalic 
version, or the use of Champetier de Ribes’ bag. 

When the os is almost fully dilated* —In these cases labor 
is going on, and it usualy suffices to rupture the membranes. 
If the bleeding continues the dilatation of the os should be 
aided by the fingers and forceps applied as soon as possible, 
or else internal version performed. 

Other forms of treatment that have been tried are the 
various methods of accouchement force. It is most impor¬ 
tant, however, to remember the increased vascularity of the 
cervix in these cases, which renders any form of forcible 
dilatation extremely dangerous. Many women have died 
from the hemorrhage due to tears of the cervix caused by 
well-intentioned efforts at delivery, who would have sur¬ 
vived the bleeding due to the placenta praevia. 

As soon as the child is born, the placenta should be 
removed manually unless the bleeding has stopped. Every 
effort must then be made to prevent post partum hemor- 
lhage, which is peculiarly apt to follow. Among other 

reasons for this are the frequency of cervical tears, the 

frequently large placental site, and the fact that the lower 
uterine segment has not, from its structure, the same 

power of retracting and sealing up the blood-vessels as is 
possessed by the upper segment. 

Prognosis. —The maternal mortality varies from i to 40 
per cent, according to the variety of placenta praevia, the 
method of treatment adopted, and the state of the patient 
when first seen. The central variety is the most dangerous, 
che marginal the least so. Women who are exhausted by 

repeated smaller hemorrhages, before a serious hemorrhage 
forces them to seek advice, have obviously less chance of 
surviving. The fetal mortality varies from about 40 to 60 per 
cent., death being due to premature separation of the 


PNEUMONIA 


placenta, to the methods of interference in favor of the 
mother, and to such complications as prolapse of the cord, 
malpresentation, etc. 

PLACENTA, RETAINED 

See Labor, Management of; and Retained Placenta. 

PLASTERS 

Plasters are preparations which are made up with resins, 
wax or lead plaster, and spread upon coarse muslin or white 
leather. They are applied to the skin, the mixture of the 
drugs which they contain is dissolved by the heat of the 
body, and the drugs are then absorbed. 

PLASTER OP PARIS 

See Bandages. 

PLEURA 

See Lungs. 

PLUMBUM 

See Lead. 

PNEUMONIA 

Pneumonia is one of the diseases in which the nursing 
care is perhaps the most important factor. It must run its 
course, but skilled nursing care can do much tc give com¬ 
fort and prevent complications. 

Pneumonia is an acute infection of the lungs and is the 
most fatal of all the acute diseases. It is called lobar or 
bronchopneumonia, according to the location of the patho¬ 
logical process in the lungs. The general principles of the 
treatment are the same in both conditions. 

Bronchopneumonia is more apt to attack the weak, infants, 
and old people, in whom the power of heat production is 
very low. It is also more apt to be accompanied by acute 
bronchitis in which cold air may be irritating and may 
increase the cough. The treatment must be modified in 
these conditions. Cold air treatment may be too severe. 

The general principles in the nursing care and treatment 
are much the same as in typhoid fever. Rest is absolutely 
essential. The patient must be spared every effort which 
means extra strain on the heart so that he may muster all 
his forces to combat the disease. Sudden movements are 
particularly to be avoided. He should be kept in the 
recumbent position with one pillow only, unless difficulty in 
breathing makes this position impossible. When in the 
semi-recumbent or sitting position he must be comfortably 
supported, prevented from sliding down and all causes of 
strain removed. He should be turned frequently, but never 


PNEUMONIA 


allowed to turn himself. Mental rest and quiet are equally 
essential; the patient knows he is ill, does not want to be 
disturbed, has enough on his mind, his attention being 
concentrated on the struggle to get enough air. 

The General Hygienic Care. —The choice and management 
of the room, the bed, care of the body, prevention of bed¬ 
sores, and the care of the eyes, nose and mouth—are the 
same as and equally essential with those in typhoid fever. 
The care of the nose, back of the nose and mouth is par¬ 
ticularly important. 

The diet varies with the length of the disease and the 
degree of toxemia. In lobar pneumonia, the patient is usually 
very toxic. The appetite is poor, digestion is impaired, and 
the course is very short, so that no attempt is made to 
force the diet. Fluid diet is given. Milk or its substitutes 
are the chief foods. Water is given in abundance and lemon¬ 
ade. orangeade, and imperial drink for the same purpose as 
in typhoid. When lobar pneumonia is prolonged or when 
complications set in, also in bronchopneumonia, which is 
more prolonged, efforts are made to increase the caloric value 
of the diet. 

The elimination of waste materials is extremely important. 
Elimination by the skin, kidneys, lungs and intestines is 
stimulated by cleansing baths, cold air or cold baths, abun¬ 
dance of water to drink, and drugs which stimulate the 
circulation or promote the action of the skin, kidneys or 
intestines. 

The symptoms to be relieved are pain, cough, fever, head¬ 
ache, delirium, restlessness and sleeplessness, dyspnea, and 
cyanosis. The complications to be feared and treated if 
present are pleurisy (always present in lobar pneumonia), 
empyema, bronchitis, myocardial insufficiency, or vasomotor 
paralysis and pulmonary edema. 

The treatments consist in the application of cold, of heat, 
and other counterirritants, rest, position, and the administra¬ 
tion of drugs. 

Cold is applied in the form of cold air, the cold chest 
compress, an ice cap, and cold baths. 

The Open-air Treatment. —In pneumonia, the beneficial 
effects of cold, open air are particularly valuable. Only 
the face should be exposed. The patient should wear a 
hood and be carefully protected from winds and drafts. 
The extremities and body, particularly the shoulders, should 
be kept snug and warm with extra clothing and a hot water 
bottle at the feet. 

Cold Baths. —The cold sponge and cold pack are used to 
reduce the fever when very high and prolonged, to relieve 
toxemia and restore the vital centers. 


PNEUMONIA 


Heat sometimes gives more comfort and' relief. Local 
applications are made to the chest. Steam inhalations give 
great relief in coughing due to bronchitis. Warm sponge 
baths sometimes relieve restlessness and sleeplessness. 

Other counterirritants —a mustard paste or drp cupping— 
are also used for the relief of pain, coughing and dyspnea. 

Strapping the chest with adhesive rests the lung, prevents 
friction and relieves pain and cough due to pleurisy. 

Venesection is sometimes performed to relieve cyanosis 
and dyspnea in strong, full-blooded patients, when the livid, 
bloated face and full, bounding pulse indicate venous con¬ 
gestion. 

Drugs. —Codeine and morphine are sometimes given to 
relieve pain and coughing. They are also given to relieve 
headache, delirium, sleeplessness and restlessness. Bromides 
veronal, trional, and paraldehyde are also used for sleepless¬ 
ness and restlessness—sleep is absolutely essential. Heart 
stimulants—caffeine, camphor, strychnine, adrenalin and 
respiratory stimulants—caffeine, atropine, etc. are given as 
required. 

The crisis in pneumonia, as the name suggests, is a very 
critical period due to the sudden drop in temperature, loss 
of heat, profuse perspiration and relief of strain on the 
heart. Marked depression and collapse may occur with a 
weak, rapid pulse, subnormal temperature, cyanosis and 
cold, clammy sweat. The patient should be watched very 
closely when the crisis is due (which may be about the 
seventh or ninth day) and the nurse should help him through 
with careful nursing, by the application of external heat, 
by rubbing the extremities, etc., with warm alcohol to im¬ 
prove the peripheral circulation and by giving heart and 
respiratory stimulants as ordered. 

Patients with an alcoholic history require particular 
watchfulness on the part of the nurse throughout the disease. 
They are more apt to suffer from heart failure and nervous 
symptoms and may develop delirium tremens. They are 
always thirsty and should be given abundance of water to 
drink. Water, nourishing diet, alcohol, and sedatives help 
to prevent extreme nervous symptoms. 

During convalescence the patient must not be allowed to 
sit up or allowed any unusual exertion without* special 
orders from the doctor, because of the danger of sudden 
death from failure of the weakened heart muscle. When 
allowed to sit up the pulse must be closely watched. Sudden 
death from pulmonary embolism is also to be feared, because 
uuring convalescence resolution is taking place. 

Prophylaxis. —Nurses in caring for pneumonia patients 
should take particular care of their own health. They should 


PNEUMONIA (POST OPERATIVE) 

be well nourished, take the proper amount of exercise, and 
should avoid fatigue, exposure, mental worry, common colds 
or anything likely to lower their resistance. The nose and 
mouth should be cleansed with an antiseptic frequently. 
Care should be taken to avoid the excretions from the nose 
and throat when the patient is coughing or sneezing, also 
care should be observed when handling these secretions and 
sputum. When open-air treatment is used, the nurse should 
be warmly clad. 

Pneumonia in Children. —Bronchopneumonia comprises 75 
per cent, of all the pneumonia in the first year. It is 
always very serious, although the outlook is better than in 
adults. Lobar pneumonia comprises nearly all the cases of 
primary pneumonia. 

The nursing care is much the same as in adults. When 
cold-air treatment is used, extreme care must be taken to 
protect from winds and drafts, and to see that the body and 
extremities are warm. Cold air is not used when bronchitis 
is present. When sponging young or feeble infants for 
fever, etc., extreme care should be taken to avoid exposure 
and chilling, as their powers of heat-production and of 
reaction are very poor. Frequent change of position is 
necessary; a young child may be held in the arms of the 
nurse. Circulatory failure is much less a cause for worry 
than in adults. Nervous symptoms—delirium, convulsions!— 
may be marked. 

PNEUMONIA (POST OPERATIVE) 

This is one of the most serious of post-operative compli¬ 
cations; and while it cannot be absolutely obviated there 
can be a marked diminution in its frequency if greater 
attention is paid to the smaller details of ante-operative and 
post-operative care. 

In hospital work and in private nursing the fact is often 
forgotten that the patient in his home has been accustomed 
to certain clothing and has been living for years under 
peculiar hygienic conditions. Upon entering the hospital he 
is given an abbreviated nightgown and placed in a bed with 
one or two blankets. When he is physically examined his 
gown is taken off, and very often there is a draught from 
a nearby open window. The deep breathing and coughing 
incident to the auscultation of the lungs often cause a 
perspiration, and the cool air on the heated skin is a poor 
combination. Occasionally the patient is asked to get out 
of bed and stand up, his bare feet very often resting against 
the cold floor; or often, when the abdomen is shaved and 
being prepared for operation, the patient is unduly exposed. 
Then from a warm bed he is placed upon a cold stretcher, 


PNEUMONIA (POST-OPERATIVE) 

wheeled through draughty, chilly halls, and plunged into 
a super-heated operating room. During the operation he 
is apt to perspire freely, and while it is routine to change a 
drenched gown, the patient, through neglect, is often per¬ 
mitted to keep it. and in this condition he is sent through 
the halls again, back into the ward. During the recovery 
period, he may toss around, uncovering his body, and 
exposing his depressed system to more draughts, more chilling, 
opening the way to a pneumonia. When the matter is 
given thought, the real wonder is that pneumonia is not 
more frequent. The best method of treating this serious 
complication is by prophylaxis. Prevention is better than 
cure, and careful and conscientious surgical nursing will 
greatly aid in diminishing the incidence of this dreaded 
complication. 

Prophylactic Treatment.—Ante-operative. —All patients be¬ 
fore operation should be carefuly examined for coryza, 
bronchitis, pharyngitis, or tonsillitis, and if any of these 
exist, the operation should not be performed, but tempo¬ 
rarily postponed. Of course, acute cases fall into another 
category, and very often it is advisable to do these under 
local anesthesia rather than run the risk of ether or gas 
administration which is sure to spread the infection into 
the lungs. If the nurse at any time prior to operation 
notices that the patient sneezes excessively, or that signs 
of a cold are developing, it is imperative that she imme¬ 
diately notify the surgeon, for few will operate when 
there is even the slightest infection of the respiratory system. 

When patients are being examined physically, or receiv¬ 
ing treatments, it is highly important that all windows and 
doors in the vicinity be closed and that draughts be 
diminished to the minimum. If a patient has to leave the 
bed he should be adequately supplied with slippers, a bath¬ 
robe, and, if necessary, a blanket. When he is moved to 
and from the operating room he should be warmly covered, 
and in the operating room the same general rules hold true. 
If his gown becomes wet with perspiration, his body should 
be thoroughly dried and a new gown supplied. 

Operative Prophylactic Treatment. —While the patient is 
recovering from the anesthetic, the lower jaw should be 
held firmly and pressed forward, exerting pressure at both 
angles; this will do much to prevent gagging, and when the 
patient vomits the head should be turned to one side, the jaw 
still being held, and the vomitus caught in a pus basin. It 
is highly important that this be always done, because if this 
procedure is routinely and regularly followed, the danger of 
the vomitus being aspirated into the lungs is reduced. 
Aspiration is not an uncommon cause of pneumonia. 


PNEUMONIA (POST OPERATIVE) 

Post-operative Prophylactic Treatment.—When the pa. 

tient arrives in the ward or room, he should be warmly 
covered and very often, in order to maintain a good body 
heat, the bed may be previously warmed either with electric 
pad or hot water bottles. If the patient tosses about, the 
blankets should always be readjusted. If there is a tendency 
to vomit the jaw should be held firmly forward and the 
head turned to one side. 

Treatment of Post-operative Pneumonia.— The treatment 

is really that of any lobar pneumonia. The patient is 
usually on a Gatch bed. The Gatch bed is one which is 
made in sections so that the upper portion of the body may 
be elevated and the knees flexed by adjusting these sections 
to any desired degree. 

The windows are opened wide and as much fresh air is 
given as possible. The diet is liquid, including milk. Fluids 
should be forced to about 3,000 c.c. a day, and the intake 
and output should be accurately measured. 

Abdominal distention is always looked for and treated 
immediately with rectal tube, enemas or colon irrigations. 

The cough is particularly distressing and dangerous, for 
after a surgical operation the pressure caused by straining 
may break some of the sutures, and sometimes the abdomi¬ 
nal wound is ruptured wide open, and the abdominal con¬ 
tents protruded. To prevent this horrible complication 
a good, tight, well-placed binder is exceedingly important, for 
it gives added support to the abdominal wall. If the cough¬ 
ing is very severe, the nurse should support the lateral 
areas of the abdominal wall with her hands. Should 
evisceration take place, the intestines should be covered 
with sterile towels, and the surgeon immediately summoned. 
For the cough, doctors will prescribe a codeine cough mix¬ 
ture, or leave orders for codeine to be given either by 
mouth or hypodermatically. 

As soon as the diagnosis is made, it is routine to admin¬ 
ister tincture of digitalis as a cardiac stimulant, the dose 
being 10 to 15 minims three times a day. If the pulse is 
very rapid, and the heart overacting, it is controlled by an 
ice bag placed over the precordium. 

Pleural pain, which is very distressing, yields to strapping 
the affected side with adhesive plaster. 

Pneumonia cases must always be watched carefully for 
cardiac failure, and edema of the lungs. The cardiac failure 
is evidenced by a weak, thready pulse, cyanosis and respira¬ 
tory difficulty. Edema of the lungs manifests itself by bub¬ 
bling respirations. 

Cardiac failure is treated by stimulants, such as camphor 
in oil, caffeine or atropine. Edema of the lungs responds 


POISONING 

best to good dry cupping especially applied to the posterior 
regions of the chest. This should be done for about twenty 
minutes at a time. Great care should always be exercised 
in preventing the patient from being burned with the cups. 
The use of oxygen in these cases is practically useless. 

POACHING 

See Food, Preparation of. 

PODOPHYLLIN 

See Podophyllum. 

PODOPHYLLUM 

Podophyllum is the underground root and rootlets of the 
Podophyllum peltatum, the May apple or mandrake, a peren¬ 
nial plant growing in Northern and Middle United States. 
Its active principle is a resin, podophyllin. It also contains 
an alkaloid, berberine. 

Action 

Podophyllum causes frequent, copious, bile-stained stools 
about eight to twelve hours after it is given. This is the 
result of its action on the duodenum. Since the bile ducts 
open into this part of the intestine, the flow of bile is also 
increased, and the stools are therefore stained with bile. 

In poisonous doses the frequent stools may cause great 
exhaustion and collapse. 

Preparations 

Resin of Podophyllum; dose ^ to i grain. 

Pills of Podophyllum, Belladonna, and Capsicum; dose 
i pill. 

Podophyllin; dose y-io to of a grain. 

POISONING 

Accidental poisoning, which may be caused in various 
ways, needs generally the most immediate attention to save 
life. These accidents are often caused by pure carelessness 
in the giving or taking of medicine in the dark or without 
looking carefully at the label, or by leaving dangerous drugs 
within the reach of children. 

Immediate treatment. —When any one is poisoned, and 
you are not sure of the antidote, do not hesitate a moment, 
but give an emetic of some kind while awaiting the arrival 
of the doctor. Mustard and salt will be found in every 
household, and are very effective. For an adult give a 
teaspoonful of mustard or salt to every glass of lukewarm 
water. Make the patient drink two or three glasses, no 
matter how he objects, and then by tickling the throat with 
the finger, the irritation will cause vomiting. Repeat in ten 
minutes so that the stomach will be thoroughly emptied. In 
case of children give ipecac instead of mustard and water. 


POLIOMYELITIS 


When there is any delay in getting the mustard or salt, 
use plain, lukewarm water in large quantities. After the 
stomach is thoroughly emptied, give an enema if the doctor 
has not arrived. When the poisoning is caused by canned 
goods or stale fish, give a large dose of castor oil as soon 
as the vomiting ceases. There are various antidotes to be 
used according to the poison that has been taken, and it is 
well to have a list of them on hand. 

Antidotes for poisons. —For Acid Poisons, such as Car¬ 
bolic Acid, Nitric Acid, Oxalic Acid, give two or three 
glasses of milk and lime-water; no oil of any kind, as it 
would only help to dissolve the acid. Do not give emetics, 
as the acid would a second time tear the tissue of the 
throat, during vomiting. 

For Irritant Poisons, such as Tartar Emetic, Arsenic. 
Paris Green, Rough on Rats, Iodine, Iron, Lead, Mercury: 
First give an emetic; then give plenty of milk, white of egg, 
or flour and water. 

For Alkaline Poisons, such as Ammonia, Lime, Saltpeter: 
After an emetic, give lemon juice or vinegar, followed by 
castor oil. 

For Narcotic Poisons the treatment is as follows: 

Aconite: Emetic, then stimulants and hot applications. 

Belladonna: Emetics, artificial respiration, heat, hot mus¬ 
tard baths. 

Alcohol: Emetics, cold to the head, and heat to the feet. 

Digitalis: Emetics and a dose of strychnine; keep the 
patient quiet. 

Opium: Emetics, strong black coffee by mouth and rectum, 
and active exercise. Patient must be kept awake. 

In all poison cases give plenty of- hot water to drink, as 
it flushes out the system (as much as three quarts is some¬ 
times used), and keep up the treatment without intermis¬ 
sion, no matter what objection the patient may make. 

Care is needed for the first few days after poison has 
been in the system, especially in regard to diet, which should 
be very simple. 

Poison from ivy. —In case of poison ivy, a wet dressing 
of bicarbonate of soda well wrapped around the inflamed 
surface is the best treatment. 

Poison from stings of insects. —Ammonia and water, salt 
and water, or bicarbonate of soda; any one of these remedies 
will remove the pain and swelling. 

POLIOMYELITIS, ACUTE ANTERIOR 

Poliomyelitis has a supposed incubation period of one to 
two weeks, a prodromal period of o to 7 days, and its 
typical symptom is paralysis of voluntary muscle somewhere; 


POLLANTIN 


one muscle, a group or several groups, anywhere in the body, 
depending on what particular nerve paths are involved in 
the central damage. 

The prodromal symptoms may be those of a mild sore 
throat, of a slight digestive upset, or of a mild grip. Some¬ 
times the patient has twitching or convulsive movements. 
Pain on movement, tender points and profuse sweating are 
often present. 

The diagnosis can only be made with surety when paralysis 
develops. 

Doubtless many light attacks pass unrecognized or even 
unnoticed, especially if they do not go as far as paralysis; 
these are known as abortive cases. 

The germ is in dispute, although no doubt a germ is 
responsible and the poison has been demonstrated. Most 
outbreaks occur in hot weather, usually in dry, hot weather. 
We do not know much about its infectiveness, but it is 
supposed to be spread by mouth-spray and hands, thus 
moving from person to person until it reaches a susceptible 
one. 

See Cerebrospinal Meningitis. 

Nursing Care in Acute Anterior Poliomyelitis. —The im¬ 
portant points in the nursing care of acute poliomyelitis are: 

Absolute rest in bed with careful adjustment of the bed 
clothes to prevent pressure and resulting deformity. A 
cradle should be placed over the feet and legs. 

A daily cleansing bath to keep the skin in good condition. 
Avoid pressure spots. 

An easily digested diet and plenty of water. 

Screen the patient from flies. 

Isolate the patient and disinfect all excretions. Dis¬ 
charges from the nose and throat are probably of the most 
danger. 

Never let patient sit up. 

Shallow, rapid respirations indicate paralysis of chest 
muscles and should be reported to the physician at once. 

Warm saline baths are frequently used when the tender¬ 
ness becomes less acute. 

For restless cases a Bradford frame is often used. 

If splints are ordered they must be carefully and per¬ 
sistently applied. 

Active treatment should not be started until after the 
acute stage (which is arbitrarily fixed at six weeks), unless 
the tenderness continues longer than this time. 

POLLANTIN (DUNBAR’S SERUM) 

This is the serum of horses that have been immunized 
against the pollen of common weeds or grasses which are 


POMEGRANATE 


believed to be the cause of hay fever. It is used in the 
treatment of hay fever and is given hypodermically or 
applied locally. 

Pollen Vaccine: This is a watery extract of the pollen 
of various weeds and grasses such as ragweed, timothy, etc., 
which are believed to be the cause of hay fever. It is 
given hypodermically in gradually increasing doses as a 
preventive for the attacks of hay fever. 


See Granatum. 

See Alcohol. 


See Alcohol. 


POMEGRANATE 

PORTER 

PORT WINE 


POSITIONS 

The chief positions used in abdominal and pelvic examina¬ 
tions are the following: 

The Horizontal Recumbent Position. —In this position the 
patient lies flat on her back with legs together and extended 
or slightly flexed to relax the abdominal muscles. One 
pillow only is allowed under the head. The arms may be 
crossed on the chest or lie loosely at the side of the body. 

The Dorsal Recumbent Position. —This position resembles 
the above except that the legs are slightly separated, the 
thighs are flexed upon the body, and the legs upon 
the thighs so that the soles of the feet rest upon the 
bed. If the patient is placed on a special examining table 
the feet rest on the extensions provided for them, and the 
patient’s buttocks are brought to the extreme edge of the 
table. 

The Dorsal Elevated Position. —This position is the same 
as the above except that pillows are placed under the head 
and shoulders so as to further relax the abdominal muscles. 
This is sometimes necessary for a proper bimanual exami¬ 
nation of the pelvic organs. 

The Dorsal Lithotomy Position. —This position is the same 
as the dorsal recumbent except that the the legs are well 
separated and the thighs are acutely flexed on the abdomen 
and the legs on the thighs. The buttocks are brought to 
the extreme edge of the table or a little beyond. To 
maintain this position and further separate the legs upright 
rods with stirrups attached are fastened to the sides of 
the table, the legs are sharply flexed backward and each 
foot is passed to the outside of the rod and fastened in 


POST OPERATIVE COMPLICATIONS 


the stirrup. A pillow or sandbag is sometimes placed under 
the hips to elevate the pelvis. The sandbag is better as it 
gives a firm, unyielding support. 

Sims’ or Left Lateral-Prone Position. —In this position the 
patient lies on her left side obliquely across the bed or 
table. One small pillow is arranged under the head so that 
the patient’s left cheek rests comfortably upon it. Her 
buttocks are brought to the edge of the mattress. Her left 
arm is then drawn behind her back and her body inclined 
forward so that she lies partly on her chest. Her right arm 
lies in front in a comfortably flexed position. The thighs 
are flexed, the right one more so than the left. The knees 
are also flexed, the right more so than the left, so that it 
crosses the left and rests on the bed. 

The Knee-cliest or Genu-pectoral Position. —As the name 
implies, when in this position the patient rests on her knees 
and chest. The head is turned on one side with the cheek 
resting on a pillow. The arms should be extended, flexed 
at the elbows and resting on the bed so as to partially 
support the patient, or they may be clasped above her head. 
They are never allowed under her. The patient rests on 
her knees which are slightly separated. The legs are 
extended, the thighs being vertical and at right angles to 
them. A small pillow may be placed under the chest, but 
the abdomen remains unsupported. The abdomen is not 
allowed to rest against the flexed thighs, because the object 
of this position is to cause the pelvic organs to fall forward. 

The Trendelenburg Position. —This position is not used in 
the ward for the purpose of examination. It is used in 
the operating room during operations on the pelvic organs 
in order to displace the intestines from the pelvis into the 
upper abdomen. A special table is necessary which can be 
adjusted so that the patient’s head is low, her shoulders held 
by shoulder supports attached to the table, her body on an 
inclined plane and her knees flexed over the adjustable 
lower section of the table, which is lowered. The legs are 
fastened to this lower section to further prevent the patient 
from slipping. 

POSITION OF FETUS 

See Presentation and Position. 

POST OPERATIVE COMPLICATIONS 

The most important of these are nausea, vomiting, perni¬ 
cious vomiting, gastric dilatation, tympanites, auto-intoxication, 
post-operative pneumonia, pulmonary embolism, urinary reten¬ 
tion, urinary suppression, phlebitis, and thrombosis. (See 
under each of these headings.) 


POST PARTUM HEMORRHAGE 


POST PARTUM HEMORRHAGE 

Of all the serious complications of a confinement, post 
partum hemorrhage is at once the most common, the most 
full of possibilities of immediate disaster, and the most 
trying to the nerve and presence of mind of the accoucheur. 
A thorough understanding of the causes and treatment is 
of the first importance, because, happily, the prognosis is 
good in cases where the treatment is prompt and correct. 

Definition. —Under the term post partum hemorrhage are 
included hemorrhage during the third stage—before the 
expulsion of the placenta—and hemorrhage in the first six 
hours following delivery. Strictly speaking, this is known 
as primary post partum hemorrhage, as opposed to secondary 
hemorrhage coming on during the puerperium and better 
known as puerperal hemorrhage. 

Varieties.—It may be divided, from an etiological point of 
view, into two varieties: 

(i) Atonic. (2) Traumatic. 

Atonic Post Partum Hemorrhage 

is the more common variety, and it includes bleeding from 
several causes, all of which, however, are associated with 
imperfect contraction and retraction of the uterus. 

Predisposing Causes 

Multiparity —especially a rapid succession of pregnancies. 
The actual cause in these cases is probably the chronic 
metritis so commonly associated with them, the muscular 
tissue being in part replaced by fibrous tissue. 

Debility, the result of chronic diseases, underfeeding, bad 
surroundings, etc. 

Overdistention of the uterus, as in hydramnios, and twins. 

Uterine fibroids. 

Ante partum hemorrhage —placenta praevia, and accidental 
hemorrhage. 

Malprcsentations and malpositions of the fetus. 

Pelvic contraction. 

Other causes of prolonged or obstructed labor. 

Primary uterine inertia. 

Prolonged administration of chloroform. 

Injudicious use of Scopolamine-morphine narcosis. 

Diminished coagulability of the blood — Hemophilia. 

Exciting Causes. — Artificial Delivery during Secondary 
Uterine Inertia. —This mistake may be said to be a direct 
invitation to disaster. 

Mismanagement of the Third Stage. —The importance of 
keeping control of the uterus throughout the third stage has 
already been mentioned. Unnecessary massage is to be 


POST PARTUM HEMORRHAGE 

deprecated, but whenever the contour of the uterus grows 
vague, or its consistence threatens to become flabby, brisk 
massage is indicated. If the hand is kept on the fundus there 
is little possibility of the uterus filling with blood without 
the obstetrician’s knowledge. 

Incomplete Separation of Placenta or Membranes .—This 
interferes mechanically with the proper retraction of the 
uterus. Simple retention of the separated placenta, or 
portions of it, may have a similar effect, particularly where 
there is already a tendency to inertia. 

Diagnosis. —This is a simple matter when the blood 
suddenly gushes from a flabby uterus. More commonly, how¬ 
ever, all that is visible is a continued ooze of blood from 
the vagina, which soaks into the bedding, and so may escar 
notice for some time. In these cases the soft uterus may 
have meantime been filling up with blood, and when the 
fundus is grasped and compressed, a large quantity of 
blood is expressed. According to the amount of blood lost, 
there is more or less collapse of the patient, with a small, 
rapid pulse, and all the other symptoms of hemorrhage— 
pallor, faintness, restlessness, etc. 

The first type of case, where the blood suddenly gushes 
out like water from a hydrant, is much the more serious. 
If not instantly treated, the patient may be dead within two 
or three minutes. Fortunately a wider knowledge of the 
correct conduct of the third stage has made this type of 
case rare. 

Treatment.—In normal labor the separation and expulsion 
of the placenta are very often accompanied by the loss of a 
few ounces of blood, and it is hopeless and valueless to 
attempt to state in actual figures what constitutes a post 
partum hemorrhage and what is still within the limits of 
normal. The loss of blood is to be measured, not in 
ounces or drams, but by its effects on the patient, for a 
hemorrhage that does little harm to one woman may easily 
prove fatal to another. 

Every case of post partum hemorrhage demands instant 
treatment. There is no time to cogitate as to what is to be 
done. It is necessary, therefore, to have in mind some 
routine of practice, and to understand the principles upon 
which it is based. Treatment is aimed at stimulating the 
inert uterus to retract properly; at removing anything inside 
it which may be preventing this; and thirdly, at mechanically 
preventing the escape of blood, until such time as the uterus 
may have recovered its normal powers. The following 
methods may be employed consecutively. Slight cases will 
yield to the simpler measures; severe ones may call for 
more drastic measures. 


POST PARTUM HEMORRHAGE 


(i) Grasp the fundus firmly between the fingers and thumb, 
massage it, and knead it until it becomes firm and definite 
in outline. If the placenta is still inside it, express it by 
Crede’s method, along with any blood-clot that happens to bt 
in the uterus. If in more serious cases the attempt to express 
the placenta fail, the hand must be passed into the uterus 
and the placenta or blood-clots removed manually. This 
indicates the desirability of always keeping the right hand 
as far as possible aseptic during a labor. Unless competent 
assistants are present there is no time to put on a glove, 
still less to resterilize the hand. 



{From Johnstone’s Textbook of Midwifery ) 

(2) Meantime the nurse should be preparing a hypodermic 
injection of ergotin or pituitary extract. Where there is 
reason to fear or anticipate hemorrhage this should be 
prepared beforehand, and be ready for use the moment the 
placenta has been removed. Pituitary extract is the most 
active drug known for stimulating uterine contractions. 
Some of the ergot preparations are, however, not far behind 
it—particularly “Ernutin” and “Aseptic Ergot”—and their 
effect is perhaps more lasting. All these drugs are supplied 
in small glass capsules, sterilized, and ready for instant use. 
The injection is best made deep into the buttock. The fluid 
extract of ergot may be given by the mouth in doses of one 
to two drams, but it is slow in action, and rather apt to 
make the patient sick. 





POST PARTUM HEMORRHAGE 


(3) Hot water at a temperature of 115° to 120 0 Fahr. 
is a potent uterine stimulant. Ice-cold water has a similar 
though less pronounced effect, but its use is contraindicated 
on account of the shock involved. The hot water is applied 
in the form of a douche—either plain sterile water, or 
weak lysol (1 dram to a pint). The douche is used vaginally 
in the first place, but if necessary it should be carried into 
the uterus, right up to the fundus, care being taken to 
provide by means of one finger alongside the douche nozzle 
a channel for the return of the fluid, or to use a two-way 
catheter. 

These measures rarely fail to stimulate the uterus to con¬ 
traction; but if they do fail, the case becomes more serious, 
and more drastic methods of treatment must be employed. 

(4) Compression of the uterus between the two hands may 
control the hemorrhage for some time. The fingers of the one 
hand are passed into the vagina against the anterior fornix, 
while the hand on the fundus squeezes the uterus down¬ 
wards on to them. If the vagina is roomy the entire closed 
fist may be passed into it. In some cases the closed fist may 
even be passed right into the uterus, which is then pressed 
down upon it by the hand on the abdomen. This is really 
equivalent to the next mode of treatment, namely— 

(5) Packing the Uterus .—If this is carefully done, it 
absolutely controls the hemorrhage. Broad sterilized gauze 
is the best material to use, but anything else suitable may 
be used, provided it is sterile. The cervix should be grasped 
by a volsellum and drawn down to the vulva, and the 
gauze passed in by the hand or a pair of long forceps. After 
packing the uterus, pack the vagina, and apply a firm 
binder over the fundus. 

The use of styptics, such as perchloride of iron or vinegar, 
is worse than useless, as to produce any effect they must 
be applied in such quantity and strength that they cause 
sloughing of the entire endometrium. 

Traumatic Post Partum Hemorrhage 

This is bleeding from tears and other injuries of the genital 
tract caused during labor. Serious hemorrhage may occur 
from tears of the cervix if they extend into the base of 
the broad ligament, or if the placenta has been situated on 
the lower uterine segment. 

Tears of the vaginal wall and the anterior part of the 
vulva in the neighborhood of the clitoris may cause very 
free bleeding. Perineal tears do not, as a rule, cause much 
bleeding. 

Diagnosis .—This is made, generally in the course of treat¬ 
ing the hemorrhage as presumably due to inertia of the 


POST PARTUM HEMORRHAGE 


uterus, by noticing that the bleeding continues in spite of 
the fact that the uterus is quite hard and contracted. Care¬ 
ful visual and manual exploration must be made to locate the 
site of the hemorrhage. 

Treatment .—Tears of the vulva and vaginal walls should 
be secured by stitches. Cervical tears may also be stitched 
after the cervix has been drawn down by a volsellum. A 
speculum and a good light are necessary. The alternative is 
to pack the tear with gauze, and even this is by no means 
easy unless a speculum and a good light are available. 

Treatment of Collapse after Hemorrhage. —The treat¬ 
ment of the collapse after a serious hemorrhage is almost as 
important as the arrest of the bleeding. It is essential to 
replace the fluid that the body has lost, and even a momentary 
anemia of the vital centers in the medulla is to be avoided. 
The head must be kept low, the foot of the bed raised, 
and the blood that is in the body conserved for the use 
of the brain and other vital organs by firm bandaging of the 
limbs from below upwards. 

The restoration of fluid to the system is best carried out 
by the injection of large quantities of warm sterile saline 
solution (one dram to the pint). The most direct method 
is that of intravenous transfusion, but injection by a large 
cannula into the submammary tissue is easier and less risky 
in private practice. Easier still, and almost equally effec¬ 
tive, are repeated slow injections into the rectum—two to 
three pints every three hours. The fluid must not be run 
in more quickly than about a pint every half-hour, or else 
it will not be retained and absorbed. Two or three drams 
of adrenalin or some pituitary extract may with advantage 
be added to the first rectal saline. 

Cardiac stimulants may also be given, but not recklessly. 
Hot black coffee with two or three ounces of brandy may be 
given per rectum, if that channel is not being used for the 
administration of saline. Brandy or ether may be injected 
subcutaneously. 

Recovery after serious hemorrhage is always tedious, and 
apt to be complicated by septic manifestations. It should 
not be hurried, as late complications such as “white leg” may 
arise. 

Puerperal Hemorrhage (Secondary Post Partum Hem¬ 
orrhage).—This may come on any time in the puerperium 
after the first six hours. In early cases it takes the form 
of excessive red lochia, in later cases of a sudden return 
of blood in the lochia. Most cases will be found to be due 
to the retention of portions of placenta or membranes, which 
may or may not have becme septic; to subinvolution; or to 
displacements of the uterus. 


POTASSIUM CHLORATE 


Sudden alarming hemorrhages are due to the retention of 
considerable portions of placenta, such as a succenturiate 
lobule. 

Continued hemorrhage coming on in the third or fourth 
week should not be allowed to pass without thorough investi¬ 
gation, as it may be due to chorion-epithelioma. 

Treatment varies with the cause. Before exploring the 
uterus, the effect of large doses of ergot, hot vaginal 
douching, and rest should be tried. If these fail, the uterus 
must be explored, and any retained portions of placenta 
removed, or displacements remedied. Chorion-epithelioma 
can only be diagnosed after curettage, and calls for imme¬ 
diate hysterectomy. 

POTASSIUM 

See Alkalies; Iodides; Saline Diuretics, and Saline 
Purgatives. 

POTASSIUM CHLORATE 

Potassium chlorate is a white crystalline powder having a 
cool salty taste. Its effects are due to the chlorate ion 

of the salt. 

Applied to the skin or mucous membranes, potassium 
chlorate contracts the tissues and acts as an astringent. It 
is therefore used to relieve inflammation of ulcerated surfaces 
or mucous membranes. It is frequently used as a gargle for 
sore throat and for ulcerations of the mouth following 

mercury poisoning. 

Potassium Chlorate Poisoning 

This condition usually results when a potassium chlorate 
gargle is swallowed by mistake. The symptoms are due to 
the formation in the blood of methemoglobin, a form of 

hemoglobin which does not combine with oxygen; and the 

red corpuscles are then unable to carry oxygen to the tissues. 
At the same time potassium chlorate injures the kidneys, 
producing symptoms of nephritis. 

Symptoms. —i. Abdominal pain. 

2. Profuse vomiting and diarrhea (the vomited matter 
contains bile or blood). 

3. Scanty urine, which may contain hemoglobin and 
methemoglobin (this gives the urine a transparent red 
color). 

4. Jaundice, with small hemorrhages into the skin. 

5. Cyanosis. 

6. Muscular twitchings, convulsions. 

7. Coma, collapse. 

Treatment. —The treatment consists in washing out the 
stomach and giving heart stimulants. The condition is best 


POTASSIUM NITRITE 


relieved, however, by removing a quantity of blood from 
a vein (and thereby a quantity of the methemoglobin) and 
replacing it by an intravenous infusion of normal salt solu¬ 
tion. 

Preparations 

Potassium Chlorate; dose 5 to 15 grains. 

It is used in 4 to 6 per cent, solutions as a gargle. 

Troches of Potassium Chlorate; each contains 5 grains. 

Sodium Chlorate; dose 5 to 15 grains. 

This has the same action as potassium chlorate. 

POTASSIUM NITRITE 

See Nitrites. 

POTASSIUM PERMANGANATE 

Potassium permanganate is a salt of manganese. 

When potassium permanganate comes in contact with 
organic substances, such as the albumins of the tissues, it 
combines with the albumins and liberates oxygen, which 
destroys bacteria; acting as an antiseptic and disinfectant. 
When it has combined with the albumins, it no longer 
liberates oxygen and is therefore not effectual. 

It is used in poison ivy rash. In India it is used for 
snake bite. 

Preparations 

Potassium Permanganate; dose 1 to 3 grains. 

For the hands and wounds it is used in 1 to 3 per cent, 
solutions. It is also used as a gargle and for douches in 
1 to 1000 to 1 per cent, solution. 

Zinc Permanganate. 

This acts like potassium permanganate and is principally 
used as an injection in gonorrhea. 

POULTICE OR CATAPLASM 

The poultice is an application of moist heat in the form of 
a soft paste which retains its heat for a varying length of 
time according to the ingredient used. The good effects of 
the poultice depend mainly upon the heat. 

The ingredients commonly used are flaxseed or linseed, 
bread, hops and digitalis. Flaxseed is the best because of its 
mucilaginous and oily ingredients. It is more soothing to 
the skin, may be used at a higher temperature without 
burning, retains its heat longest, and air can be readily 
incorporated in it, making it light and more bearable to the 
patient. 

The effects of the poultice are the same as those due to 
the fomentation and, like the fomentation, usually give the 
patient great relief and a sensation of comfort if properly 


POULTICE 


applied. If not properly applied it causes discomfort and may 
do harm. 

Poultices are used for purposes similar to the fomenta¬ 
tions, but are most commonly used as a therapeutic measure 
in the following conditions: (i) Pneumonia, to stimulate the 
absorption of the products of inflammation and congestion, 
and to relieve pain, dyspnea and cyanosis. (2) Pneumonia 
in post-operative cases to relieve distention. (3) Over pain¬ 
ful, inflamed and infected wounds, and suppurating areas. 

Tie Method of Procedure. —The important factors to con¬ 
sider in making and applying a flaxseed poultice in order 
to obtain the best results are: 

1. The temperature of the poultice should be as hot as 
the patient can stand. It is tested with the back of the 
hand or by holding it to your cheek. 

2. The size of the poultice should be large enough to 
completely cover the desired area. 

3. The poultice should be light, thick enough to retain 
the heat, of the right consistency, perfectly smooth and 
even, hot but not too hot. 

4. To insure the proper temperature, weight and con¬ 
sistency, etc., before beginning to make the poultice see 
that everything necessary is at hand so that there will be 
no unnecessary delay in applying it. The utensil used for 
mixing should be hot; the water should be boiling; the 
flaxseed is added to the boiling water gradually, at the same 
time stirring constantly with a spatula. The water must 
not stop boiling. When the mixture will drop clean from 
the spatula, it is of the right consistency. Beat the mixture 
thoroughly so as to introduce air and make it as light as 
possible. It is then spread evenly on old muslin and covered 
with gauze or muslin, in each case leaving sufficient margin 
to turn in neatly so that there can be no possible escape of 
the flaxseed. It is then wrapped in a warm towel or in a 
piece of warm flannel or old soft blanket and taken to the 
bedside. This flannel may be left on the part after the 
poultice is removed, to prevent chilling. 

Unnecessary weight is particularly to be avoided when a 
poultice is to be applied to the chest when breathing is 
already an effort, as in pneumonia. The flaxseed should not 
be more than a quarter of an inch thick. Also, when applied 
to the abdomen for distention or to other tender areas, 
the poultice should be as light as possible. To other areas 
such as the extremities, where lack of weight is not such 
an important factor, the poultice may be half an inch thick 
or more. 

5. The care of the skin and protection of the part is much 
the same as in the application of fomentations. Avoid burn- 


POULTICE 


ing the skin. Oil the skin if the applications are frequent, or 
if the skin is likely to be tender; apply the poultice grad¬ 
ually; keep raising part of it until the patient is accustomed 
to the heat. In applying a poultice to the posterior chest, 
unusual care must be taken to prevent burning as (when 
the patient is lying on his back) there is no opportunity for 
radiation of heat so that the intensity of the application or 
the heat is greatly increased. Precaution against burning 
must also be observed in distention when the skin is apt to 
be thin, shiny, stretched, and tender. Avoid exposure of 
the part before, during, or after the treatment. Cover 
the poultice with flannel or oiled muslin, so as to retain the 
heat. Fasten it in place with a binder or bandage as the 
part may demand. This should not be neglected. A patient 
who is restless, suffering from distention, mental and physical 
distress, and difficulty in breathing, as in pneumonia, or 
who is in severe pain, should not be obliged to remain in 
one position or to worry about keeping a poultice in place. 
He should not bear the weight of it “on his mind” as well 
as on his chest or abdomen. Fasten binders, etc., only tightly 
enough to retain the poultice in place, , not enough to restrict 
breathing, etc. 

When applying a poultice over an abdominal dressing to 
relieve distention in post-operative cases, a single layer of 
gauze may be placed between the poultice and the dressing 
to protect the latter. The dressing itself must never be 
interfered with. Even when a thick abdominal dressing 
covers the wound, the poultice should not be hotter than 
usual. The heat penetrates the dressing and, particularly 
when the tissues are relaxed, may so soften the tissues around 
the sutures that they give away. The same care must be 
taken when applied over all wounds, sore and suppurating 
areas. As the heat softens and expands the tissues, in some 
cases this application is contraindicated, as it gives the 
infection a chance to burrow deeper. 

6. The duration of the application in all cases should be 
only as long as the heat is retained (never longer than one 
hour), otherwise it not only causes discomfort but may 
produce an effect opposite to that desired. 

7. After the removal of the poultice dry the part. Care¬ 
fully inspect the skin. It should have a pink healthy glow 
showing the desired effect has been obtained. Oil it if 
tender or very red, and cover with soft flannel to prevent 
chilling. 

When a poultice is applied to relieve distention in pneu¬ 
monia or post-operative cases, a rectal tube is usually 
inserted into the rectum (by order) to aid in the expulsion 
of gas. 


PREGNANCY, DIET IN 


MUSTARD POULTICE 

Mustard is sometimes added to a flaxseed poultice to 
increase its irritating effect thus adding a chemical irritant 
to the physical irritant, heat. 

The proportion of mustard to flaxseed should be ordered. 
For an adult it is usually one in eight, and for a child, 
about one in sixteen. To prepare, remove all lumps from 
the mustard flour. Then dissolve it in tepid water and add 
to the flaxseed mixture just before spreading on the muslin. 
First beat the mixture thoroughly to be sure the mustard 
is well mixed in it in order to avoid burning. Some¬ 
times the flaxseed and mustard are mixed dry, then added to 
the hot water. As the mustard poultice is more irritating, 
the skin should be watched closely and the application 
removed when the skin is reddened. This usually occurs 
in from fifteen minutes to half an hour. 

PREGNANCY, DIET IN 

Adjusting the Diet. —The adjustment of the diet to cover 
the needs of the prospective mother and those of the develop¬ 
ing child is essential. The amount of food taken by the 
mother is not materially changed during the first three 
months of gestation. An average normal diet is all that 
is necessary. After this time a twenty per cent, increase in 
the woman’s diet will furnish adequate means both for her 
maintenance and for the growth and development of the child. 

Type of Food. —The kind of food which is necessary for 
the pregnant woman to take during this period is very similar 
to that taken ordinarily. It is necessary to furnish food 
materials rich in calcium and phosphorus, with an adequate 
supply of proteins in their simplest form, in order to meet 
the requirements of the growing organism. Milk and eggs 
furnish the most efficient foods in this respect and the 
prospective mother should see that they form the chief items 
of her daily dietary. Milk furnishes calcium in its most 
available form for the developing skeleton of the growing 
infant, hence it is necessary to provide the mother with 
food to replace the mineral which is withdrawn from her 
body. 

Meat in the Diet. —Meat should be eaten sparingly by the 
prospective mother, as it imposes needless work upon the 
already taxed kidneys and, if eaten in excess, will give rise 
to dangerous complications. Milk and eggs will provide 
ample protein for all purposes. 

Albumen in the Urine. —Albuminuria is one of the most 
frequent complications in pregnant women. It should be 
combated and controlled as soon as possible. The allow¬ 
ance of meat should be cut down or entirely eliminated from 


PREGNANCY, SIGNS AND SYMPTOMS OF 

the diet until the urine clears up. When albuminuria is 
persistent in spite of efforts to overcome it, the patient must 
be placed upon a strict milk diet as used in acute nephritis, 
to prevent dangerous complications arising. 

PREGNANCY, SIGNS AND SYMPTOMS OF 
Table of the Principal Signs and Symptoms of Pregnancy 
in the Order of their Occurrence 


Months. 



1 

2 

3 

4 

5 

6 

7 

8 

9 

Suppression of menstruation. 

X 

X 

X 

X 

X 

X 

X 

X 

X 

Irritability of bladder. 

X 

X 

? 






X 

Morning sickness. 

? 

X 

X 

X 

? 

? 

? 

? 

? 

Enlargement of breasts. 


X 

X 

X 

X 

X 

X 

X 

X 

Changes in size, shape, and 










consistency of uterus. 

?x 

X 

X 

X 

X 

X 

X 

X 

X 

Vaginal pulsation. 


X 

X 

X 

X 

X 

X 

X 

X 

Mammary areola. 



X 

X 

X 

X 

X 

X 

X 

Softening of cervix. 



X 

x 

x 

x 

x 

x 

x 

Intermittent contractions.... 



X 

X 

X 

X 

X 

X 

X 

Apparent shortening of cervix 



X 

X 

X 

X 

X 

X 


Discoloration of vagina. 



? 

X 

X 

X 

X 

X 

X 

Progressive enlargement of 










abdomen. 




X 

X 

X 

X 

X 

X 

Uterine souffle. 




X 

X 

X 

X 

X 

X 

Ballottement. 




X 

X 

X 

X 



Perception of active move- 










ments. 




? 

X 

X 

X 

X 

X 

Fetal heart. 











The positive signs are printed in thick type. 

And see Ballottement. 

PREMATURE INFANTS, MANAGEMENT OF 

See Infant, Care of. 

PREMATURE LABOB 

See Abortion. 

PRESBYOPIA 

See Accommodation. 

PRESCRIPTION READING 

It is important for the nurse to be able to read prescrip¬ 
tions, as she is occasionally ordered to administer a medicine, 
the ingredients of which are written in the form of a pre¬ 
scription. 

Every prescription consists of four parts: 



























PRESCRIPTION READING 


1. The superscription consists of- the date, and the name 
of the patient; which are written at the top (occasionally 
the name of the patient is written at the lower right hand 
corner), and the symbol IJ, which stands for the Latin word 
recipe, meaning “take thou.” 

2. The inscription consists of the names and the amounts 
of the ingredients used. 

The names are written in Latin, usually in the genitive 
case, for example, Camphora (genitive, Camphorae). 

The most important ingredient in the prescription is 
written first, and is often called the basis. 

The next most important ingredient is called the adjuvant, 
and is written next. 

The next substance on the prescription is usually the one 
which disguises the taste of the mixture, such as a syrup, 
and is often called the corrigent or corrective. 

The last substance on the prescription is the one in which 
all the others are dissolved, and it is often called the vehicle, 
excipient or menstruum. 

The quantities of the ingredients are written in the metric 
or apothecaries’ system of measurement. 

In the metric system, the units used are the gramme and 
milligramme. 

In the apothecaries’ system, the units used are the dram, 
grain, minim, etc. 

3. The subscription consists of the directions to the drug¬ 
gist for compounding the prescription. These are usually 
written in Latin. 

Certain abbreviations are commonly used in the subscrip¬ 
tion. The most common ones are the following: 

ss := semis (half) 

q. s. = quantum sufficiat (as much as may be necessary) 
q. s. ad = quantum sufficiat ad (as much as may be neces* 


sary to) 

M. 

= misce (mix) 

F. 

= fiat or fiant 

— make 

Div. 

= divide 

= divide 

caps. 

= capsulas 

= capsulas 

pil. 

= pilulas 

— pills 

chart. 

— chartas 

— powders 

tab. 

= tabellas 

tablets 

rt* 

P 

cr 

r-¥ 

»-»• 

r-f- 

II 

tabellas trituratas 

— tablet triturates 

troch. = 

trochiscos 

— lozenges 

supposit. = 

suppositoria 

tales 

= suppositories 
= such 


dos. 


— doses 


= doses 


PRESCRIPTION READING 


ad scat = ad scatulam = in the box 

pone in scat. = put in a box 

cochleare = spoon 

cochleare parvum = teaspoon 

The following are the most common Latin verbs used in 
prescriptions. 

adde = add 

bulli — boil 

cola = strain 

filtra z= filter 

solve = dissolve 

tere rub 

tere bene = rub well 


The following are the most common adjectives used 


aequalis 

aa. := partes aequales 
bulliens 
fervens 
saturatus 
magnus 
parvus 


= equal 
= equal parts 
boiling 
1= hot 
= saturated 
=large 
— small 


4. The signature is usually written at the end of the pre¬ 
scription and consists of the directions to the patient. It 
always begins with the abbreviation S. meaning signar=mark 
(on the label). 

The quantities to be administered are written in the 
metric or apothecaries’ system, for example, a teaspoonful 
is written 4.0 or 3 i. A dessertspoonful is written 8.0 
or 3 ii. 

The following are the abbreviations used in the signature. 
It is important for the nurse to know their definitions, as 
they may be used in her orders. 


gtt. = guttae 

= drops 

A. 

M. 

= morning 

P. 

M. 

= evening 

O. 

d. = omne die 

= daily 

O. 

m. = omne mane 

=2 every day 

O. 

n. 22: omne nocte 

= every night 

m. 

et. n.— mane et nocte 

= day and night 

t. 

i. d. = ter in die 

= 3 times a day 

b. 

i. d. = bis in die 

= twice a day 

q. 

i. d. = quatuor in die 

four times a day 



(not to be given at nig 

q. 

h. = quaqua hora 

z=: every hour 

q. 

2 h. 

=every 2 hours 

q- 

1 h. 

=every 3 hours 


PRESENTATION AND POSITION 


When medicines are ordered to be given q. 2 h. or q. 3 h. 
etc. they must always be given at night also. 

stat. = statim = at once, immediately 
s. o. s. = si opus sit = if necessary 

This refers to only one dose. More than one dose should 
not be given if a medicine is ordered s. o. s. 

p. r. n. = pro re nata = when required 

(as often as necessary) 

When a drug is ordered p. r. n. the nurse may use her 
judgment in giving more than one dose. 

a. c. ante cibum — before meals 
p. c. == post cibum = after meals 

At the end of the prescription, the physician’s name is 
signed. 

PRESENTATION AND POSITION OP FETUS 

There are several terms, used to express the position 
of the fetus in the uterus, that must be defined and explained. 

Attitude. —This is the relation of the various parts of the 
fetus to each other. The fetus in utero adopts an attitude 
characterized by universal flexion. The back is arched, the 
head bent down towards the chest, and the limbs folded in 
front with all their joints flexed. In this way the child comes 
to occupy the least possible space. 

Lie. —By this is meant the relation of the long axis of the 
fetus to the long axis of the uterus. The most common is a 
longitudinal lie where the two axes are parallel. Sometimes 
the lie is transverse, and rarely it may be temporarily 
oblique. 

Presentation.—This means the part of the fetus that 
occupies the lower pole of the uterine cavity. The presenting 
part is the actual part first and most prominently felt through 
the cervix on vaginal examination. The two terms are very 
commonly confused, and employed promiscuously. It will 
be evident now that, given a longitudinal lie, the pi esenta- 
tion may be either the herd (cephalic presentation) or the 
breech (pelvic presentation). These are Qgain subdivided 
because, owing to differences in the fetal attitude, the actual 
presenting part of the head or breech may vary. Thus a 
cephalic presentation may be either the vertex, sinciput, brow, 
or face, according to the state of flexion or extension of 
the neck. A pelvic presentation may be a full breech, a 
frank breech, a footling, or a knee, according to the state 
of flexion of the lower limbs. 

In a transverse lie the presentation is usually the shoulder. 


PRESENTATION AND POSITION 


Frequency of Head Presentations.—In 96 per cent, of all 

cases the presentation is a cephalic or head presentation. This 
figure is made up as follows: 


Vertex 
Face . 
Brow 


95.5 per cent. 
0.4 “ 

0.1 •' 


96 


44 




Vertex Sinciput. Brow. Face. 

Varieties of Head Presentation. 

(From Johnstone’s Textbook of Midwifery ) 




Of the remaining 4 per cent., breech presentations form 
3.5 per cent., and shoulder presentations 0.5 per cent. 



Varieties of Pelvic Presentation. 

(From Johnstone’s Textbook of Midwifery) 


Position. —The position of the fetus is its relation to the 
pelvis of the mother. It is described in terms of a certain 
fixed point on the presenting part called the denominator. 
For each presentation there are four possible positions accord¬ 
ing as the denominator is in one or other quadrant of the 
pelvis—left anterior, right anterior, right posterior, and 
left posterior. 







PRESENTATION AND POSITION 


In the more frequent presentations the points chosen as 
the denominators are: 

Presentation. Denominator. 

Vertex.Occiput. 

Face ..Mentum (chin). 

Breech.Sacrum. 

Shoulder .Acromion. 






Vertex R. O. P. 

(From Johnstone’s Textbook of Midwifery) 


Vertex Presentation. —The four possible positions of a 
vertex presentation are as follows: 

I. Left occipito-anterior, or L.O.A. The head lies with 
its sagittal suture approximately in the right oblique diameter 


















PRESSURE 


of the brim of the pelvis, the occiput opposite the left for¬ 
amen ovale, the sinciput opposite the right sacro-iliac joint. 

II. Right occipito-anterior, or R.O.A. The sagittal suture 
is approximately in the left oblique, the occiput opposite the 
right foramen ovale, and the sinciput opposite the left sacro¬ 
iliac joint. 

III. Right occipito-posterior, or R.O.P. The sagittal suture 
lies approximately in the right oblique, the occiput at the 
right sacro-iliac joint, and the sinciput opposite the left 
foramen ovale. 

IV. Left occipito-posterior, or L.O.P. The sagittal suture 
lies approximately in the left oblique, the occiput at the left 
sacro-iliac joint, the sinciput opposite the right foramen ovale. 

The positions are always taken in order from the left 
anterior quadrant round the pelvis because the left anterior 
is the quadrant in which it is most usual to find the occiput. 
The order of frequency of the four positions is as follows: 


I. 

L.O.A. 

70 per cent ... 

1 st in 

frequency. 

III. 

R.O.P. 

20 “ ... 

2nd 

a 

II. 

R.O.A. 

8 “ ... 

3rd 

a 

IV. 

L.O.P. 

2 “ ... 

4th 

a 


PRESSURE 

See Hemorrhage. 

PROCTOCLYSIS 

Proctoclysis is rectal irrigation. 

Articles required: 

1. Irrigator stand and can. 

2. Rubber sheet 20 X 30 inches. 

3. Bath towel, dressing towel. 

4. Hot water bag. 

5. Tray, provided with: 

(a) Special proctoclysis tube and accessories. 

(b) Glass graduate containing fluid, salt solution one-half 

physiological strength, at temperature of ioo° to 
105° F. 

(c) Bath thermometer. 

(d) Vaseline, applicator. 

Procedure.—Place rubber sheet covered with bath towel 
under buttocks, adjust tubing, pour liquid into irrigating 
can, and allow to run through until the tube is warm, lubri¬ 
cate tip with vaseline and insert carefully. Regulate flow, 
which is usually 3 drops per second. If necessary to hold 
nozzle in place, apply a strip of adhesive plaster over tube 
close to nozzle and fasten to patient’s thigh. See that tem¬ 
perature of fluid is maintained throughout treatment. Watch 


PROSTATE 


patient carefully to see that absorption is taking place and 
fluid is not expelled. 

If regular proctoclysis outfit is not used, a proctoclysis 
tube or a catheter No. 1 2 E may be substituted. To main¬ 
tain temperature, a hot water bag or can placed on bed at 
side of patient and a part of the tubing brought in contact 
with it will keep fluid warm. Renew in irrigating can as 
fluid becomes cool. 

PROPESIN 

See Anesthesin. 

PROSTATE 

One of the most common operations done upon the male 
genital tract is that of prostatectomy, removal of the pros¬ 
tate gland. This is performed for simple hypertrophy, or 
for cancer. It is known that the prostate consists mainly 
of three lobes, the middle coming into close relationship with 
the urethra and the lateral lobes coming into relationship 
with the rectum. When the prostate increases in size, it fol¬ 
lows the path of least resistance and projects into the 
bladder, and the increase in the size of the median lobe 
interferes with the free passage of urine because it obstructs 
the internal opening of the urethra. This results in fre¬ 
quency of urination, then urinary retention which must be 
relieved by a catheter, and from frequent catheterizations a 
condition of cystitis is very often established. The suffering 
is quite severe, and the only measure affording permanent 
relief is the removal of the obstruction (prostatectomy). 

Prostatectomy 

This operation is often preceded by a period of improving 
the patient’s nutrition, and his urinary output by regular 
catheterizations. The operation resolves itself into a choice 
of perineal or suprapubic prostatectomy. 

Perineal Prostatectomy. —The perineum is shaved and 
eight hours before operation the usual soap-suds enema is 
given. The patient is placed in a lithotomy position with 
the pelvis raised by sand bags and the prostate is enucleated 
through the perineum. 

Post-operative Treatment. —The retained catheter is con¬ 
nected to bottle drainage and the urine collected. The gauze 
tampon which usually occupies the space of the removed pros¬ 
tate is taken out on the fifth day; the catheter is removed 
on the seventh, and from then on the urethra is treated with 
sounds of various sizes. 

Suprapubic Prostatectomy— In this procedure the prostate 
is removed through the bladder. It is done in two stages. 
The first operation is a suprapubic cystotomy, the second the 


PROTARGOL 


actual removal of the gland through the previous bladder 
wound. 

First Stage: —As a rule, catharsis is given forty-eight hours 
previous to the day of operation. Before operation the 
bladder is irrigated and often some novocaine or alypin is 
injected. The bladder is kept distended and the cystotomy is 
done under local anesthesia. A button drainage tube is 
placed in the opening of the bladder and the tube clamped. 
When the patient arrives in his room the clamp should be 
removed from the tube and the bladder drained continuously, 
or intermittently. The diet should be very light and soft, 
fluids allowed in liberal amounts. 

Second Stage: —While some surgeons proceed to enucleate 
the prostate immediately after cystotomy, the majority wait 
five or more days before completing the operation. Naturally 
there will be rather a profuse hemorrhage following the 
blunt dissection of the gland. This may be controlled by 
tampons, but a better result is obtained if a bag hemostat 
is used. This is made of rubber, is inflatable and when 
distended and placed within the bladder exerts pressure 
on the bleeding areas. One connection of the bag passes 
through the urethra, and is the means by w'hich air is intro¬ 
duced. This is removed in twenty-four to forty-eight hours. 

The suprapubic wound is freely drained, and at the end 
of forty-eight hours a button tube is inserted, connected to 
the bottle drainage and the patient allowed out of bed. At 
the end of a week the patient is encouraged to void, and as 
soon as he does so in sufficient amounts, the suprapubic tube 
is removed. Of course, the urine will leak in small amounts, 
but the sinus is healed in from the thirteenth to the twentieth 
day. 

Cancer of Prostate 

In the early stages this is treated by prostatectomy. In 
the late periods, radium is tried as a palliative procedure. 

PROTARGOL 

Protargol is a compound of albumin and silver containing 
8.3 per cent, of silver. It is used as an antiseptic, and as an 
astringent on mucous membranes in 1 to 10 per cent, solu¬ 
tions; as irrigations in 1 to 1000 to 1 to 2000 and in the 
form of bougies and tampons in 5 to 10 per cent, solutions. 

PRUNUS VIRGINIANA (WILD CHERRY) 

Primus Virginiana is obtained from the bark of the wild 
cherry tree. Its active principles are amygdalin, a glucoside, 
and a ferment, emulsin. 

Prunus Virginiana is often given to increase expectoration 
and lessen coughing, together w'ith other cough medicines. 


PSYCHONEUROSES 

Syrup of Prunus Virginiana (15 per cent, strength); dose 
1 to 4 drams. 


PRUSSIC ACID 

See Hydrocyanic Acid. 

PSYCHASTHENIA 

See Psychoneuroses. 

PSYCHONEUROSES 

The psychoneuroses include neurasthenia, psychasthenia 
and hysteria. 

Neurasthenia 

Neurasthenia is a nervous disorder, or neurosis, char¬ 
acterized by mental and physical fatigability, irritability of 
mood and various hypochondriacal ideas. It is commonly 
called “nervous prostration.” 

Physical symptoms. —These are loss of appetite, loss of 
weight, although sometimes these patients are well nourished, 
headache, with feeling of weight or pressure or of a tight 
band about the head, insomnia and feeling of exhaustion 
on awaking, muscular weakness and fatigue on slight exer¬ 
tion, constipation, gastric and cardiac distress, pain in the 
back of the neck and at the end of the spine and many other 
discomforts. 

Mental symptoms. —These patients are over-sensitive to 
external impressions especially of sound—the wind, the trees, 
the crickets and natural sounds which are beyond control, or 
of sounds which originate from people, humming, whispering, 
talking, creaking of shoes, closing of doors, etc. They are 
self-centered, irritable, anxious, depressed, restless, unable 
to apply themselves to any mental work and have many 
hypochondriacal ideas. 

Psychasthenia 

Psychasthenia is a more serious disorder of the nervou* 
system, and is characterized by obsessions, phobias, doubti 
and feelings of anxiety and insufficiency. It is sometimei 
called a “border line” disorder, for it lies between a neuros^. 
and psychosis and has characteristics of both. 

The physical symptoms are much the same as in neuras 
thenia. The mental symptoms are obsessions—ideas whick 
besiege and possess the mind against the desire and will, 
phobias or morbid fears of crossing open spaces and bridges, 
of high places, of closed rooms, of being alone, of the dark, 
or dirt, etc., doubts about insignificant matters like closing 
a door or posting a letter, inability to decide even the 
simplest matters, what to do next, which shoe to put on first. 


PSYCHONEUROSES 


etc., feelings of anxiety and insufficiency, of being unable 
to do what is expected of them and of being unequal to the 
duties of life. 


Hysteria 

Hysteria is a morbid state of the nervous system in which 
the mind produces symptoms simulating some forms of 
organic disease. 

Fhysical symptoms. —These patients are as a rule well 
nourished, but there may be loss of appetite and loss of 
weight. Other symptoms may be nausea, vomiting, difficulty 
in swallowing, “globus hystericus,” rapid or slow pulse, 
rise of temperature, dyspnea, hiccough, peculiar cries, whoops 
and noises which simulate the cries of animals, contractures 
and paralyses, aphonia, fainting spells, tremors, rhythmical 
spasms and convulsions. The convulsions may resemble 
epilepsy, but the patient as a rule does not fall heavily, 
nor where much injury can be done, and does not bite the 
tongue severely. There is a rare form in which the convul¬ 
sive attacks are very severe and continue for several days. 

Mental symptoms. —Disturbances of sensation are common 
and there may be hyperesthesia or anesthesia of a small area 
or of a whole part of the body; hearing is often rendered 
more acute, or it may be lost, and sight may also be lost; 
hallucinations may be present; amnesia for certain events 
and conditions is common; the emotions show great fluctua¬ 
tions and the mood may vary from elation to depression; 
the disorders of conduct may range from stupor to delirium, 
and many acts which are extremely dangerous and may 
result fatally are committed for the purpose of exciting alarm 
or sympathy. 

Nursing procedures. —These are among the most trying 
and difficult patients to nurse, for the mental impairment is 
so slight, and the lack of self-control, the irritability, the 
incessant questioning, groundless worries, hesitation and 
indecision tax the patience and resourcefulness of the nurse 
to the utmost. The mind is so often alert, and they appear 
so sensible, that it is difficult at times not to feel that they 
could be different if they would; and this is where much 
of the difficulty lies, the lack of power to will. But it must 
be remembered that in their minds they truly suffer and 
need careful and intelligent nursing. 

When the general condition needs rest and building up, 
the physician prescribes “Rest cure,” a form of treatment 
first employed by Dr. S. Weir Mitchell. This consists of 
separation from the family or friends, either at home or in 
hospital, preferably in hospital, for it has been proved that 
the absolute obedience which is imposed by the physician 


PSYCHONEUROSES 


is more readily gained when the patient is removed from his 
accustomed surroundings, which are associated with his 
illness, and from the family and friends who too often 
express undue sympathy for the symptoms and uninten¬ 
tionally criticize and interfere with the treatment; absolute 
rest of body and mind, for the patient is put to bed and is 
not allowed to have so much as a newspaper or a letter; 
regular diet at fixed hours with sometimes a diet of milk 
exclusively for a number of days followed by a sudden, 
unexpected change to full diet; passive exercise by massage; 
some form of hydrotherapy, a cold pack or warm bath at 
bedtime to combat the insomnia; and, in so far as possible, 
the exclusive service of a special nurse. The duration of 
this treatment ranges from four to ten weeks depending on 
the response of the patient. When repose of body and mind 
is complete, a return to normal activities is gradually made 
by first sitting up in bed with a back rest, then in a chair 
for definite periods. At this time the patient is permitted 
to read a little, to receive a letter, etc. During this period 
the nurse must be alert to detect the recurrence of old ideas 
and note carefully the reaction to them. 

In the treatment of these disorders very little is left to 
the decision of the patient in the beginning, for a routine or 
program which provides for every hour in the day is pre¬ 
scribed by the physician. These orders must be punctually 
and fully carried out. Many times there is a desire on the 
part of the patient to compromise some part of it, to revert 
to the old ways of doing only what was agreeable and con¬ 
venient, and here the nurse must show no hesitation, no 
indecision, but demand that the full requirement of the 
order be met. The nurse who has won the confidence and 
respect of her patient, and has learned to make simple, 
direct and positive statements, will not have much difficulty 
in carrying out the physician’s directions. 

All unnecessary nursing procedures should be avoided, 
for many patients have been made worse by the solicitous 
ministrations of their family, who in their eagerness have 
tried to appease and satisfy every whim and notion. Listen 
patiently to all the patient will tell, for to unburden the 
mind affords great relief, and be sympathetic with the 
patient but not with the symptoms. Do not ask how he 
slept or how he feels, but assume that he slept well, that he 
feels better day by day, that improvement is being made and 
that recovery is sure to come. A nurse who is genuinely 
interested and sympathetic, punctual in carrying out the 
orders prescribed, who is cheerful, patient, yet decisive and 
firm, hopeful and eager for recovery, can do much towards 
arousing the patient from his unhappy and miserable state 


PUBERTY 


and help him to attain one of hopefulness, interest and 
usefulness in the future. 

As progress is made some forms of occupation are given, 
the planting of seeds, growing of bulbs and plants, sprouting 
wheat seeds in a sponge, copying, memorizing, the study 
of birds, bees, trees and flowers, all the various forms of 
handiwork, simple household tasks, and light gardening, 
gradually increasing the demand for both physical and 
mental energy until a normal condition has been attained. 

PUBERTY 

See Menstruation. 


See Lice. 


PUBIC LOUSE 


PUERPERAL HEMORRHAGE 

See Post Partum Hemorrhage. 


PUERPERAL INFECTION 

Under this heading are included all the morbid conditions 
arising in the puerperium as a result of the introduction of 
organisms into the genital tract before, during, or after 
labor at full term, miscarriage, or abortion. 

Etiology. —The following organisms have been found: 

Streptococcus Pyogenes. —This is the cause of the most 
grave and epidemic forms of the infection. Frequently in 
the most virulent cases it is found in company with other 
organisms, especially the B. Coli communis. 

Staphylococci Pyogenes Aureus et Albus. —These common 
pus-forming organisms are found everywhere—on the skin, in 
dust, and especially in sores or eruptions. Hence the pecu¬ 
liar risk of any sores on the person of either the nurse or 
obstetrician. 

Bacillus Coli Communis. —This organism is always present 
on the vulva owing to the proximity of the anus. Hence the 
importance of cleansing the genitals of the patient before 
labor, and during the puerperium. 

Gonococcus. —That this organism may cause puerperal infec¬ 
tion there is no doubt, although the infection is rarely acute. 

The following pathogenic organisms have also been found: 

Bacillus Diphtherice (Klebs Loeffler); Diplococcus Pneu- 
monice; and Bacillus Tetani. 

The all-important facts are that pyogenic organisms are 
never, under normal circumstances, present in either the 
vagina or uterus, and that, if they are found in these situa¬ 
tions, they have been introduced from without. The only 
exception to this statement is the gonococcus, which is able 
to live in the vagina in spite of the acid-forming bacilli, and 


PUERPERAL INFECTION 


sometimes lies latent there or in the cervix, and becomes 
activated again during the puerperium. 

Sources of Infection. —These have already been discussed 
under the management of labor. It must be remembered 
that even a perfectly cleansed hand or a sterile instrument 
may be a source of danger by conveying organisms from 
the vulva. Therefore the cleansing of the vulva is equally as 
important as the cleansing of the hands and instruments. 

Specially strict precautions ought always to be taken if 
the physician or nurse has been recently in contact with a 
case of puerperal or surgical sepsis, because infection from 
such a source seems to be particularly virulent and dangerous. 

Clinical Aspects of Puerperal Infection 
Sapremia. — Local Symptoms. —If the infection has oc* 
curred during labor the symptoms may show themselves on 
the second or third day; but if the infection occurs later, 
the symptoms appear correspondingly later. The principal 
local sign is that the lochial discharge becomes increased in 
amount, dirty brownish in coior, and very fetid in odor. 
The stain on the diaper, which is usually dark in the center 
and pale at the edges, tends in such cases to be dark at 
the edges and pale in the center. The involution of the 
uterus ceases, and that organ remains unduly large, soft, 
and tender. 

General Symptoms. —These are ushered in by a rise of 
temperature—rarely higher than 102°—accompanied by some 
feeling of chilliness, but rarely by a definite rigor. The 
pulse rate rises in correspondence with the temperature. 
There is generally some headache' and general malaise. If 
untreated, the general condition may become serious, and a 
septicemic infection may ensue, indicated by rigors, per¬ 
sistently frequent pulse, and high temperatures. 

Septicemic Infection. —In the cases falling under this 
heading the infecting organisms are pathogenic or pyogenic 
in nature, the streptococcus, staphylococci, and Bacillus Coli 
communis being the commonest. They live and flourish in 
living tissues, and are thus capable of passing into and 
multiplying in the blood. The pathological changes are 
those of septic endometritis, and the symptoms vary in inten¬ 
sity according to whether the organisms are stopped by the 
protective layer of leucocytes in the uterine wall, or succeed 
in penetrating into the lymphatics, and so into the general 
systemic circulation. In the former case the patient usually 
slowly recovers; in the latter we are dealing with a general 
septicemia, and the outlook is much more giave. 

In septic endometritis the symptoms usually come on not 
later than the third day. Speaking generally they closely 


PUERPERAL INFECTION 


resemble those of sapremia, but are more severe. The first 
symptom is usually a sharp rise of temperature, to which 
attention is drawn in many cases by a rigor. The tempera¬ 
ture may rise to 103° or 104°, and fall rapidly with the 
profuse perspiration that generally follows. Thereafter the 
temperature tends to remain high with small and variable 
daily remittences. The pulse-rate is markedly increased, and 
an important point is that it does not necessarily correspond 
to the temperature, remaining high even when the tem¬ 
perature has fallen. In this respect the pulse is a better 
guide to the patient’s condition than the temperature. 

Locally the uterus is probably rather unduly large, but 
the process of involution is not so characteristically inter¬ 
fered with as in sapremic conditions. It is usually tender 
on palpation. The lochia are generally, but by no means 
invariably, diminished in quantity, and in severe cases may 
be altogether suppressed. They are fairly normal in ap¬ 
pearance, and are not characteristically fetid as in sapremia. 
If the infection is mixed, there may be fetor, but in serious 
cases of streptococcal infection there is an entire absence 
of it. The mammary secretion is frequently suppressed. 

General Septicemia .—If the infective process passes be¬ 
yond the endometrium, the symptoms become more severe. 
Each fresh extension of infection is marked by a rigor, 
and a further rise of the temperature and pulse. Involve¬ 
ment of the peritoneum usually causes abdominal pain. The 
patient looks very ill, the eyes sunken, the nose pinched, and 
the skin slightly jaundiced or muddy. The mind is usually 
clear, even up to a very short time before death, but occa¬ 
sionally delirium or coma supervenes. The tongue, which 
is clean and moist in mild cases, becomes furred and ulti¬ 
mately dry, glazy, and cracked. Vomiting may occur, espe¬ 
cially when general peritonitis has developed, and “black” 
vomiting is of grave prognostic significance. Diarrhea with 
offensive motions is a late symptom and also of serious im¬ 
port. It may, however, be induced by the injudicious use of 
mercurial salts in the douches. Rashes are not uncommon 
in grave cases; sometimes merely transient miliaria due to 
the perspiration, but often scarlatinaform, or in the form of 
erysipelatous patches. 

If general peritonitis develops, there is usually pain over 
the whole abdomen, but most marked over the uterus, with 
resistance and tenderness on palpation. The abdomen also 
becomes distended from paresis of the bowels. The patient 
lies on her back with the knees drawn up. Vomiting is 
common, and in the later stages diarrhea. 

Cases in which acute general septicemia or acute general 
peritonitis have developed usually end fatally within a week. 


PUERPERAL INFECTION 


Pyemia is very liable to occur in the course of more 
protracted cases. It may occur as an additional complication 
in a case that has been more or less acute from the outset, 
but sometimes it arises abruptly about the end of the first 
week in cases in which only a slight degree of pyrexia has 
been observed. Its main features are exactly the same as 
those of pyemia arising from other sources, the principal 
characteristic being a succession of rigors with high tem¬ 
perature and pulse-rate, with definite remittences of pulse 
and temperature between the rigors. The rigors indicate 
fresh detachments of infected thrombi. Metastatic ab¬ 
scesses form where the thrombi lodge, either in the superficial 
tissues or in the viscera. Septic endocarditis, pneumonia, 
empyema, and pericarditis are amongst its possible results. 
The seriousness of the case varies with the virulence of 
the infection and the situation of the metastatic abscesses. 

Prognosis 

The prognosis of pure sapremia is good, but unless a bac¬ 
teriological examination has shown the case to be one of 
uncomplicated sapremia, the prognosis should be guarded, be¬ 
cause a case that begins as sapremia may pass on into a 
septic infection. 

In septic cases the prognosis is much more serious. Even 
if the infection is not very virulent such cases are apt to 
be protracted, and open to relapse at any time, while late 
complications such as parametritis, phlegmasia alba dolens, or 
pyemia may supervene. In acute general septicemia or 
general peritonitis the outlook is almost hopeless. 

Treatment 

Prophylaxis. —The main points to which attention should 
be paid, are: 

(1) The patient should be brought into as good a condition 
of health as possible before labor so as to be able to resist 
any morbid process. This involves careful attention to 
the hygiene of pregnancy. 

(2) Both obstetrician and nurse must endeavor to avoid 
contact with any infectious patient, particularly one with 
puerperal septicemia, or any septic wounds. Where this is 
unavoidable, they must exercise the most conscientious care 
in disinfecting themselves, changing and disinfecting clothes, 
etc. 

(3) Above all, strict attention to antiseptic and aseptic 
precautions must be observed in every- contact with the pa¬ 
tient immediately before, during, and after labor. 

(4) Vaginal examinations should be as few as possible. 

(5) Each stage of labor must be properly managed so as 


PUERPERIUM 


to avoid exhaustion, unnecessary lacerations, and hemor¬ 
rhage. 

(6) All lacerations should be repaired at once so as to 
close up possible channels of entrance of infection. 

(7) After the birth of the child neither finger nor instru¬ 
ment should be allowed to enter the vagina, unless absolute 
necessity demands it. 

PUERPERIUM, MANAGEMENT OF 

General Management. —As soon as labor is over and the 
patient has been made comfortable as described under the 
management of the third stage of labor, the first essential 
to secure for her is Rest. To this end she should be left 
to sleep, the baby being removed to another room, and the 
blind being drawn. The room should not be made so dark 
that any undue pallor of the face will not be observed. 

Visitors, except the patient’s husband or mother, should 
be rigorously excluded for two or three days, and after that 
the nurse must exercise her discretion as to the admission 
of other friends, the safe rule being that the fewer there 
are the better. Sleep is of the first importance, and the 
mother should be encouraged to sleep for two hours every 
afternoon during the lying-in period. 

The vulvar pads for the absorption of the lochia must be 
changed at frequent intervals, depending on the amount of 
discharge, but not less than every four hours for the first 
few days. Each time a fresh pad is applied the vulva should 
be gently cleansed. 

Strict asepsis must be the inviolable rule in the manage¬ 
ment of the puerperium. The nurse must carefully wash 
her hands and soak them in an antiseptic before she handles 
the patient’s genitals. In cleansing the vulva, pledgets of 
sterile or antiseptic wool soaked in biniodide or weak lysol 
must be used, one pledget for each wipe, and all wiping 
being done from before backwards. The same care must 
be observed when the patient uses the bed-pan. In a normal 
case it is unnecessary and undesirable to employ antiseptic 
vaginal douching. 

The temperature is taken in the mouth at 8 a.m. and 
5 p.m. In practice any temperature over 99, and any pulse 
over 90, requires to be investigated and the reason found. 
In all cases attended by a trained nurse a chart of the pulse 
and temperature, etc., should be strictly kept. 

Bladder .—There may be difficulty in passing urine. The 
usual adjuvants, such as hot water in the bed-pan, hot 
(antiseptic) fomentations to the perineum, etc., should be 
tried. Failing these the patient may be gently turned round 


PULMONARY EMBOLISM 


on her hands and knees. If this fails, and if the bladder 
is distended so as to form a palpable tumor above the 
symphysis, the catheter must be passed. This requires the 
most scrupulous asepsis in its performance. The patient 
must be placed on her side, the vulva exposed with clean 
hands, and the vestibule wiped free of lochia with an an¬ 
tiseptic swab. The catheter must be boiled before use, and 
passed by sight. 

Bowels .—It is advisable to give a brisk laxative on the 
evening of the second day. Half an ounce or more of castor 
oil is probably the best, but may be replaced by licorice 
powder, or an aloin and nux vomica pill. If the patient is 
not going to nurse, the laxative should be given on the 
second morning, and should take the form of a brisk saline 
purge—magnesium sulphate, for example. 

Diet .—If the patient feels so inclined she may have a cup 
of warm milk, weak tea, or gruel immediately after labor. 
For the first twenty-four hours the diet should be quite 
light and mainly fluid—milk, tea, coffee, cocoa, gruel, etc., 
with toast or bread and butter. Custards and soups may be 
added the following day, and after the bowels have been 
moved the ordinary diet may be gradually and rapidly re¬ 
sumed. It is a mistake to keep a healthy puerperal woman 
on a low diet. The best diet for a nursing mother contains 
much milk food, with no spiced foods or other indigestible 
articles. 

After the first day the patient should be propped up with 
two pillows to nurse her child, and after lactation is estab¬ 
lished she may take her meals in the same posture. After 
the fifth day she may be allowed to sit up, but it is best 
to keep her in bed until at least ten days have elapsed. If 
the patient can stay in bed for a fortnight, so much the 
better. After that she should be allowed up on a couch, 
one hour the first day, two hours the second day, and so 
on. By the end of the third week she may be allowed 
out for a drive, and in the following week for short 
walks. 

PULMONARY EMBOLISM (POST-OPERATIVE) 

This is not very common, and may occur after the simplest 
operations; for example, after an appendicectomy, or an 
operation for varicose veins; it may be preceded by a 
thrombosis of the veins of the lower extremity, or come as 
a distinct entity. As a rule, it is ushered in by a sudden 
pain in the chest, dyspnea, bloody expectoration, rapid pulse, 
and slight rise in temperature. If the chest is auscultated 
the doctor may sometimes note a friction sound, or signs of 
beginning pneumonia may be evident. Occasionally, instant 


PULSE 


death occurs, and at best the mortality is high, varying from 
seventy to eighty per cent. 

Treatment. —Patients who develop a phlebitis or thrombosis 
of the veins of the lower extremity, or any other region, 
should be kept in bed until this condition absolutely sub¬ 
sides, because a small piece of blood clot may break off, 

and lodge in the lung as an embolus. Patients should not 
be permitted to be too active after operation even if their 
condition is excellent. The treatment of embolism is to 
reassure the patients, for they are apt to become greatly 

alarmed at the sight of their bloody expectoration. To 

further quiet them morphine is administered. If the diag¬ 
nosis of its location is made, it is customary to strap that 
side of the chest in which the embolus is lodged. This will 
immobilize the affected lung as much as possible. 

The family of a patient suffering from a pulmonary em¬ 
bolism should be apprised of the impending danger, for even 
though the patient may recover from the shock of the 
embolism itself, it may give rise to an embolic pneumonia 
and a recovery from this condition is exceptionally rare 

although it occasionally occurs. 

PULSE 

When the finger is placed on an artery, a sense of re¬ 
sistance is felt, and this resistance seems to be increased 
at intervals, corresponding to the heart-beat, the wall of 
the artery at each heart-beat being felt to rise up or dilate 
under the finger. This alternate dilatation and contraction 
of the artery constitutes the pulse; and in certain arteries 
which lie near the surface this pulse may be seen with 
the eye. When the finger is placed on a vein, very little 
resistance is felt; and, under ordinary circumstances, no 
pulse can be perceived by the touch or by the eye. 

As each expansion of an artery is produced by a contrac¬ 
tion of the heart, the pulse, as felt in any superficial artery, 
is a convenient guide for ascertaining the character of the 
heart’s action. 

Locations where the pulse may be felt.—The pulse may be 

counted wherever an artery approaches the surface of the 
body. These locations are: 

(1) The facial artery, where it passes over the lower jaw¬ 
bone. 

(2) The temporal artery, above and to the outer side of 
the outer canthus of the eye. 

(3) The brachial artery, along the inner side of the biceps 
muscle. 

(4) The radial artery, on the thumb side of the wrist. On 


PURGATIVES 


account of its accessible situation the radial artery is usually 
employed for this purpose. 

(5) The femoral artery, where it passes over the pelvic 
bone. 

( 6 ) The dorsalis pedis, on the dorsum of the foot. 

Points to note in feeling a pulse. —In feeling a pulse the 

following points should be noted: 

(x) Frequency, or the number of pulse-beats per minute. 

(a) Strength, or the force of the heart beat. 

(3) Regularity, or the same number of beats per minute. 

(4) Equality. —Each beat should have the same force, not 
some strong and some weak. It sometimes happens that a 
beat is missed because the heart-beat is too weak to distend 
the artery. This called an intermittent pulse. 

Occasionally there is a lack of tone in the arterial walls 
and a dicrotic pulse is felt. This means that the pulsations 
are divided and the second part of the beat is weaker than 
the first. 

(5) Blood pressure. —This is suggested by the amount of 
force that is required to obliterate the pulse. 

Average frequency of the pulse. —The average frequency 
of the pulse in man is seventy-two beats per minute. This 
rate may be increased after eating or by muscular action. 
Even the variation of the muscular effort entailed between 
the standing, sitting, and recumbent positions will make a 
difference in the frequency of the pulse of from eight to 
ten beats per minute. Mental excitement may also pro¬ 
duce a temporary acceleration, varying in degree with the 
peculiarities of the individual. Age has a marked influence. 
At birth the pulse rate is about 130 per minute; at three years, 
100; in adult life, 72; in old age, 65. It is somewhat more 
rapid in women than in men and is lowered during sleep. 
Idiosyncrasies are frequently met with. A person in per¬ 
fect health may have a much higher or a much lower rate 
than 72. The relative frequency of the pulse and respira¬ 
tions is about four heart-beats to one respiration. 

As a rule, the rapidity of the heart’s action is in inverse 
ratio to it's force. An infrequent pulse, within physio¬ 
logical limits, is usually a strong one, and a frequent pulse 
comparatively feeble; the pulse in fever or debilitating affec¬ 
tions becoming weaker as it grows more rapid. 

PUMPKIN SEED 

See Pepo. 

PURGATIVES 


See Cathartics. 


PYELITIS 


PYELITIS 

See Kidneys, Surgical Conditions of. 


PYEMIA 


See Sepsis. 


See Stomach. 


PYLOROSPASM 

PYONEPHROSIS 


See Kidneys, Surgical Conditions of. 


PYOSALPINX 

See Fallopian Tubes, Diseases of. 

PYRAMID ON 

Pyramidon is an artificial chemical substance which acts 
like antipyrin. It relieves nervous pains and headaches. 
It reduces temperature slowly, but the temperature stays 
down longer. In large doses it weakens the heart action. 
Dose is i to 6 grains. 

See Antipyretics. 


PYROGALLOL 

Pyrogallol or pyrogallic acid is a light crystalline sub¬ 
stance made by heating gallic acid. 

The action of pyrogallol is similar to that of carbolic acid. 

Applied to the skin or mucous membranes it checks the 
growth of bacteria, acting as an antiseptic; it destroys par¬ 
asites and produces redness of the skin. It usually stains 
the skin or clothing a dark brown, color. 

Pyrogallol is occasionally absorbed from the skin and pro¬ 
duces poisonous symptoms which resemble those of carbolic 
acid poisoning. (See Carbolic Acid). 

Pyrogallol (Pyrogallic Acid) is used in the form of 5 
to 20 per cent, ointments. 


Q 


QUASSIA 

A drug obtained from the wood of Picrssna excelsa, 
a large tree which grows in Jamaica. It contains an active 
principle, quassin. 

Preparations 

Fluidextract of Quassia; dose 5 to 30 minims. 

Tincture of Quassia; dose 15 to 60 minims. 

A 10 per cent, infusion of quassia is given as an enema 
for round worms in children. 

QUEECUS 

Quercus is the bark of the white oak tree. It contracts 
the tissues and checks the secretions of the mucous mem¬ 
branes, because of quercitannic acid which it contains. It 
is used as an enema in prolapsus recti or hemorrhoids, and 
as a vaginal douche. 

Preparation 

Fluidextract of Quercus; dose 15 minims. 

QUICKENING 

By this is meant the first conscious feeling by the mother 
of the movements of the fetus in the uterus. Most com¬ 
monly it occurs at the fourth and a half month, or just 
about mid-term. The first felt movements are very feeble, 
and ha\e been likened to the “fluttering of a bird in the 
closed hand.” By the primigravida they may be mistaken 
for flatulence or colic, but the multipara will be able to 
recognize them. If the movements are not felt by the 
hand of the examiner little weight can be attached to this 
as a sign of pregnancy. 

QUICKSILVER 

See Mercury. 

QUININE AND CINCHONA 

Quinine is a white powder, an alkaloid, the active prin¬ 
ciple of cinchona, or Peruvian bark. This is the bark of the 


QUININE 

cinchona tree, which grows in the Andes or other moun¬ 
tainous districts on the western coast of South America. 
Besides quinine, the active alkaloid, cinchona contains the 
alkaloids, quinidine, cinchonine, and cinchonidine. They 
resemble quinine in their effects; which are weaker, how¬ 
ever. 

Appearance of the Patient 

When quinine is given to a patient suffering from malaria, 
it prevents the chills, fever and sweats, which are char¬ 
acteristic of that disease. 

After administration of a single average dose of quinine, 
the patient usually complains of a bitter taste in the mouth, 
he feels brighter, and the pulse is perhaps somewhat more 
rapid and stronger. If there has been fever, the temperature 
is lowered several degrees. 

If the quinine is given for some time, the patient feels 
better, he has a better appetite, his bowels move more 
regularly, he feels brighter and stronger and is more active. 
The pulse is somewhat stronger and more rapid, the breath¬ 
ing is deeper and somewhat more rapid. 

Local action: Applied to tlie skin or mucous membranes, 
quinine causes slight redness and acts as an antiseptic. It 
is not generally used as an antiseptic, because it is too ex¬ 
pensive. It is said to increase the growth of hair and 
therefore forms an ingredient of many hair tonics. 

Internal Action. In the mouth: Because of its very 
bitter taste quinine increases the appetite and the secretion 
of saliva. 

In the stomach: It lessens the action of pepsin, thus re¬ 
tarding the digestion of protein food. In large doses, it 
occasionally causes nausea and vomiting. 

In the intestines: It retards the action of the trypsin of 
the pancreatic juice, and increases the secretions and peri¬ 
stalsis, often causing frequent movements of the bowels. 


Action after Absorption 

Quinine is slowly absorbed into the blood, principally from 
the stomach. When it enters the blood, it acts as a specific 
for malaria, and it slightly affects the nutrition and the 
action of all the tissues and organs. 

Effect of Quinine in Malaria. —If a patient suffering 
from malaria is given quinine, the quinine enters the blood 
and destroys the plasmodia. The chills, fever and sweats 
are then prevented, and the disease is cured. The use of 
quinine must be continued for some time, however, even 
after the symptoms have disappeared; until all the plas¬ 
modia in the blood are destroyed, and the patient is free 
from attacks. 


QUININE 


Effect on nutrition and metabolism: Quinine increases 
the nutrition of the tissues and organs of the body, by pre¬ 
venting the nitrogenous, or protein food from being used 
up. In this way quinine acts as a tonic, slightly improving 
the action of all the tissues and organs of the body and 
making the patient feel better and stronger. 

Action on the blood: Besides its destructive action on 
malarial parasites, quinine prevents the red blood corpuscles 
from taking up oxygen as readily as before. It also lessens 
their number and checks the movements of the white blood 
corpuscles. 

Action on the circulation: The pulse is made somewhat 
stronger and faster, because the contractions of the heart 
and blood vessels are increased. Large doses occasionally 
cause a slow and weak pulse because of the slightly weak¬ 
ened contractions of the heart. 

Action on the nervous system: Quinine lessens nervous¬ 
ness and neuralgic pains. 

Action on the senses of sight and hearing: Large doses 
of quinine very frequently cause ringing in the ears, and 
dimness of vision. 

Action on the uterus: Quinine increases the contractions 
of the uterus during labor; it occasionally causes abortion. 

Effect on temperature: The temperature is lowered be¬ 
cause oxidation of the nitrogenous or protein substances 
of the tissues is lessened, and less heat is produced. 

Excretion 

Quinine is eliminated from the body by the urine, mostly 
in about 6 to 8 hours. 

Idiosyncrasies 

Many individuals are especially susceptible to quinine, 
even small doses causing poisonous effects. In some indi¬ 
viduals, the following unusual symptoms occur, even from 
very small doses: 

1. Eruptions on the skin, such as areas of redness re¬ 
sembling the scarlet fever rash, hives or urticaria, and oc¬ 
casionally small blisters. 

2 . Occasionally scanty urine, accompanied by pain; often 
the urine is tinged with blood or hemoglobin. 

3. Slow and weak pulse, and a feeling of weakness. 

Poisonous Effects 

Since quinine is very frequently given in large doses for 
malaria, poisonous effects are not uncommon. These effects 
result from continued use of quinine, or from very large 
doses taken to produce abortion. While the symptoms which 
result may be alarming, they are rarely, if ever, fatal. 


QUININE 

Symptoms. —The first and most characteristic symptom 

of quinine poisoning is: 

Ringing in the ears, or roaring sounds in the ears. 
Often the patient may become temporarily deaf. Rarely 
the deafness remains permanent. 

2. Dimness of vision, especially for colors. 

3. Temporary blindness or “color blindness ” The blind¬ 
ness is occasionally permanent. 

4. Nausea and vomiting. 

5. Slow, weak pulse. 

6. Muscular weakness. 

7. Collapse. 

Treatment. —The symptoms usually subside when the drug 
is stopped. If they do not disappear, they are usually relieved 
by bromides. If the pulse is weak, caffeine, given hypoder¬ 
mically, or a hot coffee enema, usually improves it. 

Uses 

Quinine is used principally in the following conditions: 

1. As a specific in malaria. 

2. As a bitter, to increase the a’ppetite; and as a tonic to 
improve nutrition. 

3. To reduce fever. 

4. To destroy the amebse, unicellular organisms which 
cause amebic dysentery, a chronic disease of the intes¬ 
tines. In these cases quinine is usually given by irrigations 
into the colon or large intestine. 

Administration 

In malaria, quinine is usually given in one single large 
dose of 15 grains about 4 hours before the time when the 
chill should occur. It may also be given in divided doses, 
so that the last dose is given about the time of the expected 
chill. By the time the quinine enters the blood, the para¬ 
sites are very young and are readily destroyed. It may 
also be given in divided doses when the temperature is 
going down, after the chill. The administration of quinine 
should be kept up, however, for about a week after the 
attack is over, to prevent a recurrence of the symptoms. 

1. Quinine is best given in solution after meals, since 
the presence of acid in the stomach aids the absorption. 
The addition of a drop of dilute sulphuric acid to the fluid 
'vill also aid the absorption. 

Quinine is frequently given in the form of powders or 
pills. The pills are usually not very efficient unless they 
are fresh. Old quinine pills may pass out in the stools with¬ 
out being absorbed. The addition of a few drops of dilute 
sulphuric acid usually makes the quinine preparation more 
soluble. 


QUINSY 


2 . On account of its unpleasant, bitter taste, quinine 
should be given in sherry wine, in cachets or capsules, or 
some food, such as olive oil, may be given afterwards. 

3. For its bitter effect it should be given before meals in 
fluid form, undiluted. 

Preparations 

Fluidextract of Cinchona; dose 1 dram. 

Tincture of Cinchona; dose 1 to 4 drams. 

Compound Tincture of Cinchona; dose 30 to 60 minims. 

The cinchona preparations are used principally as bitters 
to increase the appetite. For malaria and as a tonic, quinine 
preparations are preferable. 

Quinine; dose 5 to 15 grains. 

Quinine Bisulphate; dose 5 to 15 grains. 

This is the most common preparation used, as it is the 
most soluble one. 

Quinine Sulphate; dose 5 to 15 grains. 

Quinine Hydrobromide; dose 5 to 15 grains. 

Quinine Hydrochloride; dose 5 to 15 grains. 

Cinchonine Sulphate; dose 8 to 20 grains. 

Cinchonidine Sulphate; dose 8 to 20 grains. 

Iron and Quinine Citrate; dose 5 to 10 grains. 

Syrup of Iron, Quinine and Strychnine Phosphate; dose 
1 dram. 

Elixir of Iron, Quinine and Strychnine Phosphate; dose 
1 dram. 

Warburg’s Tincture. 

This is a dark brown liquid which is used extensively in 
India, in the treatment of malaria. It contains a large 
number of ingredients besides quinine, such as aloes, rhubarb, 
gentian, camphor, etc. 

Quinine and Urea Hydrochloride; dose 5 to 15 grains. 

This preparation is suitable for hypodermic use. It is 
also used as a local anesthetic injected hypodermically or 
applied to mucous membranes. 

Quinine Tannate; dose 10 to 30 grains. 

This preparation is slowly absorbed, and has no bitter 
taste. 


QUINSY 

See Pharynx, and Peritonsillar Abscess. 


R 


RABIES 

See Hydrophobia. 

RADIUM 

Radium is a chemical element obtained from Hungary. 
The salt commonly used in medicine is radium bromide. 
This usually comes in sealed glass tubes enclosed in gold, 
silver or platinum. Radium differs from other chemical 
substances in a very singular way. It is constantly giving off 
atoms in the form of invisible rays which are capable of pro¬ 
ducing energy and destroying tissue. Substances which 
have this property are said to be radio active. The constant 
loss of the atoms takes place so slowly that the action of 
the radium is not materially lessened by constant use. 

The active rays of radium are able to destroy tissues and 
are of three kinds: alpha, beta and gamma rays. The 
gamma rays are the most penetrating and are able to 
reach deep tissues, while the alpha and beta rays affect only 
the superficial cells. The alpha rays may be screened off by 
interposing a piece of paper between the radium and the 
tissue to be affected, and the beta rays by a thin piece of 
lead. 


Action 

Radium acts only locally, on direct application to the 
tissue to be treated. If a tube of radium is applied for some 
time on the normal skin, it will produce a red and tender 
area with the formation of a scab. A longer application, 
or a stronger tube, will form an ulcer which heals readily, 
however. 

When applied for some time to a cancer, radium destroys 
some of the cancer cells, checks its growth and relieves the 
pain. 

Uses and Administration 

Radium is used principally in the treatment of cancer and 
rodent ulcer (a peculiar progressive form of ulcer which 
spreads over the face and destroys the various tissues). 


RECTAL FEEDING 

It is usually applied by inserting the gold, silver, or 
platinum covered tube of radium into the cancer tissue or 
by placing it on the ulcer. 

Thorium and Mesothorium are two other radio active sub¬ 
stances that are used in the treatment of cancer. They are 
much cheaper than radium but not as active. 

Radium Emanation 

Radium emanation is a gas which is constantly being 
given off from radium. It is obtained by placing a radium- 
containing substance in a bottle of water and allowing it 
to stand for some time, when the water becomes charged 
with the emanation. This is used as a drink in chronic 
rheumatism and gout with beneficial results. 

The gas may also be collected from the surface of the 
water and used as an inhalation in the treatment of dis¬ 
eases of the lungs. 


RECTAL FEEDING 

Rectal feeding is used when the other organs of digestion 
are impaired to such an extent as to render the need of more 
food obligatory. Many investigators believe that rectal 
feeding is absolutely useless, while others have firm faith in 
its efficacy. 

Technique of Rectal Feeding. —The rectum should be 
cleansed by flushing with a soapsuds enema one hour before 
nutrient enema is given. This should be done once a day, 
in the morning. The cleansing enema may be either soap¬ 
suds, a solution of bicarbonate of soda, or boric acid (i tea¬ 
spoonful to the pint), or a saline solution. When there is 
much mucus, or if the rectum is inflamed, the soda or boric 
acid solution may be more soothing than the saline or soap¬ 
suds enema. After one hour’s rest the patient should be 
given a nutrient enema. 

The method of administering nourishment through the 
rectum is important. A nutrient enema injected only into 
the lower bowel not only does no good, but may actually 
cause a good deal of unnecessary discomfort to the patient. 

Temperature of Enema. —Care must be taken not to have 
the temperature of the nutrient enema too hot or too cold or 
it will be promptly rejected. The patient is placed on the 
side with one knee flexed; the solution is poured into a 
fountain syringe bag or an enamel container (heat the con¬ 
tainer before pouring the solution into it or the latter will 
be chilled). The bag or container has attached to it a 
rubber tube with a cock adjusted so that only a small stream 
will flow in at a time. To the end of this tube a rubber 
rectal tube ©r catheter—i cm. (about J 4 inch)—is attached. 


RECTAL TUBE 


This should be well greased (do not use glycerin as this 
substance is irritating to the mucous lining of the rectum). 
The liquid should be allowed to fill the tube before it is 
inserted into the rectum, to prevent any air passing in with 
it. The tube should be inserted with a gentle twisting move¬ 
ment, using very little force or the tender mucous mem¬ 
branes will be injured. Insert the tube twelve or more 
inches, since the solution is more completely absorbed if 
given high up in the bowel. The bag containing the solution 
should be held only a few inches higher than the rectum, 
thus allowing only a small stream to pass in and allowing 
an air space above the stream for the passage of gas which 
may be accumulated in the upper part of the rectum. The 
tube should be allowed to remain in the rectum for fifteen 
or twenty minutes, then very gently withdrawn to prevent 
the liquid from being rejected. A pad of gauze may be 
pressed against the anus to assist the patient in retaining 
the enema. It is well to divert the attention of the pa¬ 
tient also, to further assist her in retaining the liquid. 

Duration of Rectal Feeding. —Rectal feeding cannot be sub¬ 
stituted for a great length of time, first, because the patient 
cannot absorb sufficient nourishment in this way to fully 
cover the body requirements, and, second, because the rectum 
becomes more or less sensitive and will reject the liquid 
before it has an opportunity to be absorbed. From three 
to four nutrient enemas a day is about the limit for the 
average patient. Between the nutrient enemas it is advis¬ 
able to give one of saline solution. 

The following regime is practiced during the “Total Ab¬ 
stinence Period” in the treatment of gastric ulcer: 7 a.m., 
cleansing enema; 8 a.m., nutrient enema; 1 p.m., nutrient 
enema; 3 p.m., saline enema; 6 p.m., nutrient enema. One 
saline and one nutrient enema may be given during the 
night if the patient is very weak. She should not be 
wakened, however, to be given the enema. 

RECTAL TUBE 

See Tympanites, Post-operativf. 

RECTOCLYSIS 

See Rectum, Administration of Medicines by. 

RECTUM, ADMINISTRATION OF MEDICINES BY 

Remedies are given by rectum for the following effects: 

1. To move the bowels. 

2. To medicate diseased condition of the rectum, sigmoid 
or colon. 

3. For absorption, to cause general effects. 


RESINS 


Enema: For a cathartic effect the object of injecting a 

fluid into the rectum is merely to distend the bowels. This 
starts peristalsis and causes movements of the bowels. 
Drugs are usually given for this effect by means of an 
enema. When it is desired to inject fluid into the sigmoid 
or descending colon the patient should be placed in the 
knee elbow position. 

Irrigation: To affect the mucous membrane of the rectum 
or descending colon or to remove gas or fluid, irrigations 
are used. The method consists of injecting fluid into the 
rectum and siphoning it back. An ordinary enema can, 
with a tube and tip, is used. The lubricated tip is inserted 
into the rectum, the fluid is allowed to run in and is then 
siphoned back by alternately elevating and lowering the 
can. Every time the can is lowered below the level of 
the patient the fluid should return from the rectum. 

An excellent method of irrigating is by means of Kemp’s 
irrigating tube, which consists of an inflow and outflow 
tube in one. The inflow tube is connected with the can 
by means of a rubber tube. When the fluid is allowed to 
run into the rectum it returns through the outflow tube. 

For absorption: Remedies are frequently given by rec¬ 
tum for absorption, in cases where it may not be possible 
or where it is harmful to administer them by mouth. They 
may be given in the form of suppositories which consist of 
cocoa butter impregnated with the drug. These are inserted 
into the rectum, the cocoa butter dissolves, is absorbed and 
carries the drug with it into the blood stream. 

Substances are absorbed more readily from the rectum, 
however, when given by the Rectoclysis or Murphy method. 
The method is the same as an irrigation, but a return flow 
is not desired. The essential feature of this method is to 
allow the fluid to run in slowly, drop by drop, so that it is 
absorbed and does not distend the intestine. The drug to 
be administered should be dissolved in a large quantity of 
water (about a pint to a quart). Normal salt solution should 
not be used as a solvent as it is not absorbed as readily 
as water. Many remedies, such as the salicylates, are oc¬ 
casionally given by this method. 

RENAL CALCULUS 

See Kidneys, Surgical Conditions of. 

RESINS 

Resins are thick, sticky substances which form the sap 
of many trees. Most of these substances can be dis¬ 
solved in alcohol but not in water. Some resins are solid; 
for example, the rosin used by violinists. 


RESORCIN 


RESORCIN 

Resorcin or resorcinol is a chemical substance made from 
carbolic acid. 

The action of resorcin is like that of carbolic acid. 

Local action: Applied to the skin it checks the growth of 
bacteria; acting as an antiseptic and disinfectant. 

When given internally it produces the following effects: 

1. It checks the growth of bacteria in the stomach and 
intestines. 

2. It reduces temperature, and increases perspiration. 

3. It makes the pulse slower. 

Overdoses of resorcin produce the same poisonous effects 
that result from carbolic acid poisoning. 

See Carbolic Acid. 

Uses 

Resorcin is used principally as an antiseptic in skin dis¬ 
eases, such as dandruff baldness, etc. It is occasionally 
used as an intestinal antiseptic and to reduce temperature. 
Dose 5 to 10 grains. 

Externally resorcin is used in 5 to 10 per cent, solutions. 

RESPIRATIONS 

What to Observe when Taking the Respirations.—A nurse 

must observe the rate and character of the respirations, the 
movements and expansion of the chest and abdomen, the 
color of the patient, and the position he may instinctively 
assume. 

The Rate of the Respirations.—The average rate for a 
healthy adult is from 14 to 18 per minute, but it is greater 
in childhood (20 to 25) and in infancy (30 to 40). In 
health there is a uniform relation between the frequency of 
the pulse and of the respirations in the proportion of one 
respiration to four or five pulse beats. In health the res¬ 
pirations increase in rate and force under the same condi¬ 
tions as the heart to meet the needs of the body, but in 
disease this relation may cease. The respirations are usually 
increased with the pulse, but not always in equal propor¬ 
tions. 

The Character of the Respirations. —Respirations are de¬ 
scribed as “deep” or “shallow,” depending upon whether the 
volume of air inspired and expired is greater or less than 
normal. “Rapid” respirations are usually “shallow.” 
Whatever interferes with the proper expansion of the chest, 
or with the inlet or outlet of air, or with the functioning 
area of the lungs, will decrease the volume of air inspired 
or expired. 

See Cheyne-Stokes Respiration. 


RETAINED PLACENTA 


RESPONSIBILITY 

See Insanity, Legal Aspect. 

REST CURE 

See Psychoneuroses. 

RETAINED AND ADHERENT PLACENTA 

A retained placenta is one which has been separated from 
the wall of the uterus, but is not expelled owing to the 
weakness of the uterine contractions. Its presence prevents 
complete retraction of the uterus, which is already somewhat 
atonic, and there is usually a good deal of hemorrhage. 

An adherent placenta is one which has failed to separate 
after an hour in spite of active uterine contractions. This 
abnormal adhesion of the placenta is rarely, if ever, com¬ 
plete. There is almost always some amount of separation, 
and therefore some amount of bleeding. If the adhesions 
are general all over the placental area, there is no hem¬ 
orrhage; but if a portion separates while the rest remains 
adherent, the complete retraction of the exposed part of the 
placental site is interfered with, and post partum hem¬ 
orrhage follows. 

Treatment. —If the placenta fails to come away sponta¬ 
neously within forty minutes or an hour after the birth of the 
child, an attempt should be made to express it by Crede’s 
method. Failure to expel it by this method, carefully and 
correctly performed once or twice on an actively contract¬ 
ing uterus, indicates some abnormal adherence. In these 
cases the placenta must be removed by hand. 

In all cases, if there is post partum hemorrhage, and the 
placenta cannot be expelled by Crede’s method, it must be 
removed by hand without delay. 

With strict aseptic precautions, and more especially since the 
adoption of sterilized rubber gloves, the risk of the pro¬ 
cedure has been greatly diminished. The patient should be 
brought to the edge of the bed, and the vulva thoroughly 
washed with an antiseptic lotion. The right hand, similatly 
cleansed, should be slipped into a sterilized rubber glove, 
and dipped in a weak solution of lysol or other sterile lubri¬ 
cant. The hand should then be passed gently into the 
Uterus, following up the cord, and the edge of the placenta 
nought for, the fundus being meantime pressed down by 
the other hand on the abdomen. The gloved fingers should 
then be insinuated by a sawing movement between the 
placenta and the uterine wall, and the whole placenta gradu¬ 
ally separated and removed. After its removal the hand 
should be again introduced to make sure that no small bits 


RETENTION OF URINE 

have been left behind, and, if so, to remove them. This 
again should be followed by a hot antiseptic douche and a 
hypodermic injection of ergot or pituitary extract. 

RETENTION OF URINE 

See Urine, Retention of. 

RETROVERSION 

See Uterus, Malpositions of. 

RHAMNUS PURSHIANA 

See Cascara. 

RHATANY 

See Krameria. 

RHEUMATIC FEVER 

In the nursing care of acute rheumatic fever, we have to 
consider a patient suffering from an acute, local inflamma¬ 
tory process in the joints with excruciating pain, stiffness, 
and swelling, and also from fever and general toxemia with 
pyrexia, thirst, loss of appetite, constipation, scanty, very 
acid urine and profuse sweats having a sour odor. 

The complications to be feared are endocarditis, peri¬ 
carditis, myocarditis, pneumonia, pleurisy, hyperpyrexia, and 
nervous complication—delirium, coma, stupor, prostration 
and chorea due to the concentration of the poisons on the 
nervous system. 

The room selected should be sunny, cheerful and well 
ventilated. The patient should be protected from drafts and 
from changes in the temperature. He should wear a flannel 
gown, and if he perspires freely should lie between blankets 
to prevent chilling from the drenching sweats and to avoid 
the clammy, sticky feeling of wet sheets. The shoulders 
should be well protected. The gown should be open down 
the front and sleeves (if the arms are involved) to allow 
applications with the least amount of disturbance. 

The care of the skin is extremely important on account of 
the sour odor and irritating quality of the acid sweats. 
The care of the buttocks is also important on account of 
the sweat and acid urine. Alkaline baths, alcohol rubs and 
keeping the skin dry with powder will keep the skin in good 
condition. 

The care of the mouth is the same as in all fevers. 

The diet and care regarding proper elimination are also 
much the same. When the salicylates are given, constipa¬ 
tion is particularly to be avoided on account of the danger 

of acidosis. 


RHUBARB 


Rest, not only of the painful extremity, but of both mind 
and body, is absolutely essential. Cardiac complications 
are to be feared with the mildest attack. All causes of 
restlessness and sleeplessness are to be avoided. The dis¬ 
ease is acute and apt to be prolonged so that the patient 
needs all his energy. 

The relief of pain is necessary to secure rest and sleep 
and if pain is not relieved, it will wear the patient out. 
Every movement may mean pain and even without move¬ 
ment the pain may be severe. Extreme care should be used 
in making the bed, in turning, lifting, or moving the pa¬ 
tient, in the use of the bedpan, and in the application of 
treatments, etc. Avoid even touching or leaning on the 
bed unnecessarily—the patient will often scream with alarm 
at the mere thought. A cradle is used to support the 
weight of the bedclothes. Pain is relieved by rest, position, 
the local application of heat, cold, counterirritation, and 
by the use of drugs. Heat may be applied by simply wrap¬ 
ping the limb in lint, cotton or flannel bandages, or in the 
form of fomentations, the cautery, thermal light rays or 
antiphlogistin. When applying heat, the joint should be 
protected from changes in temperature. Cold is applied in 
the form of an ice-bag, ice-coil or cold compresses. Various 
soothing lotions, such as lead and opium, are frequently 
ordered. Methyl salicylate is applied as a rubefacient. Can• 
tharides may be used in the form of the fly blister. 

The drugs used chiefly to relieve pain are preparations of 
salicylic acid, which is antiseptic, antipyretic, and also 
anodyne. Commonly used preparations are sodium salicylate, 
aspirin, salicin and methyl salicylate. 

Acute Rheumatism in Children is said to be the cause of 
practically all the heart diseases. It differs from that in 
the adult in that the joint involvement is less severe, sweating 
is less profuse, but the heart suffers more. Chorea is also 
more common. Watch for twitching, fidgety, vague, jerky 
movements. The mental attitude is apt to be unstable, so 
that the child is easily upset or excited and laughs or cries 
easily. Rest, quiet, and very careful nursing are essential. 

RHUBARB 

Rhubarb is obtained from the root of the Rheum officinale. 

Rhubarb acts principally upon the large intestine as a 
purgative, producing frequent fluid stools, not accompanied 
by griping. These stools are colored with bile. On account 
of the tannic acid which it contains, rhubarb constipates 
after its purgative action. 

The urine, and in nursing women, the milk, is colored 
yellow when rhubarb is taken. 


RHUS GLABRA 

Rhubarb is particularly valuable in cases where solid 
masses in the stools produce pain. For example, in hemor¬ 
rhoids, by softening the stools, the pain produced by the 
passage of hard fecal masses, is often relieved. 

Preparations 

Extract of Rhubarb; dose 5 to 10 grains. 

Compound Rhubarb Pill; dose 1 to 5 pills. 

This contains aloes, myrrh, oil of peppermint and 
rhubarb. 

Compound Rhubarb Powder (Gregory’s powder); dose 
15 to 60 grains. 

This contains magnesia, ginger and rhubarb. 

Aromatic Syrup of Rhubarb; dose Vfc to 2 drams for a 
child. 

Rhubarb and Soda Mixture; dose 2 drams. 

This also contains ipecac and is used more for stomach 
conditions than as a cathartic. 

RHUS GLABRA (SUMACH) 

Rhus glabra is obtained from the fruit of Sumach berries. 
It contains tannic and malic acids. 

It is used as an astringent gargle, diluted in two parts 
of water, for sore throat and pharyngitis. 

RICKETS 

Rickets is a constitutional disease, due to disturbed nutri¬ 
tion, developing in infancy and early childhood, generally 
between the sixth and eighteenth months. The exact cause 
of this disease is still unknown, but it is much more com¬ 
mon in artificially fed infants than those receiving breast 
milk. This may be due to the fact that the mineral salts, 
like the other constituents, are combined in the mother’s 
milk in measures which meet the needs of the baby more 
efficiently than is the case in cow’s milk. The metabolism 
of the phosphorus and calcium in rickets is interfered with, 
and the bones of babies suffering from this disease show a 
diminished amount of calcium and phosphorus and an in¬ 
creased amount of water. As the disease progresses the 
bones bend into deformities, owing to the lack of calcium, 
which gives rigidity and permanence to the skeleton. 

Dietetic Treatment. —The treatment of rickets is essentially 
one of diet. There is no doubting the fact that good breast 
milk is the best food in this condition, as it is in all nutri¬ 
tional disturbances, but when it is impossible to secure it 
for the baby, the next best thing is a properly modified 
milk formula. This formula must be made to suit the 
digestive capacity of the individual infant at the time. It 


ROSE 


is believed, however, “that it is well to keep the per¬ 
centage of fat lower and that of the carbohydrates higher 
than would ordinarily be done.” This is probably done on 
account of the effect upon the retention of calcium and 
phosphorus in the body of the infant exerted by the different 
food constituents. 

Calcium in the Diet. —In cow’s milk the calcium content 
is in excess of the needs of the baby, hence there is no 
reason whatsoever to give the rachitic baby additional cal¬ 
cium. If the baby is not breast fed or is not receiving a 
modified cow’s milk, then he may not receive sufficient 
calcium for his needs, in which case the diet must be 
changed to one or the other. Care must be observed not 
to give too rich a food, since in this way the baby’s ability 
to handle a sufficient amount would so limit the calcium 
intake as to make it insufficient. 

Excess Fat and Calcium Retention. —As has already been 
mentioned, it is probable that an excess of fat in the food 
may interfere with the calcium retention, on account of 
the combining of the salts and the fats and in this way 
interfering with the absorption of the former substance. 

Fresh air and plenty of sunshine are necessary in the 
treatment of rickets. In some cases where anemia is pro¬ 
nounced, it is found advisable to give some form of iron. 

RINGWORM 

See Skin Diseases. 


ROASTING 

See Food, Preparation of. 

ROCHELLE SALTS 

See Saline Purgatives. 

ROSE (ROSA GALLICA) 

Rosa galllca is made from red rose petals, gathered from 
the unopened buds. It is used as a mild astringent and as 
a flavoring ingredient. It usually comes in the foim of a 
fluid extract, a honey, a syrup, and a confection, for flavor¬ 
ing purposes. 

For local use, the following preparations are used: 

Rose Water; Stronger Rose Water; Cold Cream or Rose 
Ointment. 


RUSSIAN MINERAL OIL 


ROUND WORMS 

See Anthelmintics. 

RUBBING A PATIENT 

There are innumerable times in sickness when rubbing 
is needed and if well done gives a great deal of comfort 
to the average patient. Regular massage is the science of 
exercising the muscles and requires very exact knowledge 
and should not be confused with ordinary rubbing:—this 
rubbing increases the circulation under the skin and soothes 
the nerves by relieving the tension and tends to keep the 
whole skin healthy, particularly when normal exercise is 
restricted as with the sick. 

In order to make a smooth motion, use even pressure of 
the whole hand and don’t press in with the fingers and 
have a little lubricant or powder on the hand. 

In the extremities, follow the course of the veins, rub¬ 
bing toward the heart and from the head down. For the 
forehead rub over the eyes, using the tips of the fingers 
lightly and press outward. 

For the arm, hold the wrist in one hand and rub up 
with the other. 

When rubbing the lower extremity stand facing the foot 
of the bed and draw the strokes toward you (this gives your 
arm freer action). The abdomen is sometimes rubbed when 
patient is constipated and the direction should be up the 
right side, across the top and down the left side. 

To rub the back, have the patient turned toward you 
and rub out from either side of the spine and for the 
shoulders and lower part of the back rub with circular 
motions, making the skin move Under your hand. The 
back requires frequent rubbing. 

RUBEFACIENTS 

See Counterirritants. 


RUM 


See Alcohol. 


RUPTURE 


See Hernia. 

RUSSIAN MINERAL OIL 

See Liquid Petrolatum. 


s 


SABROMIN 

Sabromin is an organic salt formed by the combination ot 
calcium and dibrombehenic acid. It produces the same 
effects as the bromides, but they come on slower and last 
longer. It is said to have a more pleasant taste and not 
to upset the stomach. It usually comes in tablets, each 
containing 8 grains. The dose is from 8 to 60 grains. 

SACCHARIN 

Saccharin is a chemical substance which has a very sweet 
taste. It is 200 times sweeter than sugar and is used to 
sweeten foods for diabetic patients. It is usually given in 
half grain doses together with 5 grains of sodium bicar¬ 
bonate, since it dissolves more readily in alkaline solutions. 

SACCHARUM LACTIS 

See Sugar of Milk. 


SALICIN 

See Salicylic Acid. 

SALICYLIC ACID AND THE SALICYLATES 

Salicylic acid is a white crystalline powder which is made 
chemically by the action of sodium hydroxide (caustic soda) 
and carbonic acid, on carbolic acid. 

The salicylates are salts formed by the combination of an 
alkali with salicylic acid. 

Many salicylates are found in various plants. For ex¬ 
ample, methyl salicylate is found in the oil of wintergreen, 
or oleum gaultheriae. 

There are many new artificial preparations made chemi¬ 
cally from salicylic acid or its salts, some of which, such 
as aspirin, are extensively used. 

Appearance of the Patient 

About 15 minutes after an average dose of salicylic acid, 
or one of the salicylates, is given, the patient complains of 


SALICYLIC ACID 


a slight burning pain in the pit of the stomach, and pos¬ 
sibly of a slight feeling of fullness in the head. Soon he 
sweats profusely, and the temperature is lowered i or 2 
degrees, particularly if there is fever. The pulse may be 
somewhat faster and stronger, unless a large dose has been 
given, when it may be slightly slower and weaker. The 
breathing is usually somewhat more rapid, and the patient 
passes more urine. 

If the patient is suffering from acute articular rheuma¬ 
tism, the pains and swellings around the joints are gradu¬ 
ally relieved. 

Local action: Salicylic acid and the salicylates are anti¬ 
septics. They also soften the epidermis or hard layer of the 
skin when directly applied. On mucous membranes, they 
cause redness and increased secretions (irritation). 

Internal Action.—In the mouth: They have a peculiar 
salty, sour taste. 

In the stomach: Salicylic acid and the salicylates increase 
the secretions. If given when the stomach is empty, they 
are apt to cause burning pain in the stomach, occasionally 
nausea, and possibly vomiting. 

In the intestines: They have an antiseptic action, check¬ 
ing the growth of bacteria. 

Effect of Salicylates 

Salicylic acid and the salicylates are used principally as 
specifics for acute articular rheumatism; the pains become 

lessened in a few days, the redness and swelling of the 
joints are diminished, the temperature subsides, and the 
patient soon gets well. 

Effect on temperature: The salicylates reduce the tem¬ 
perature several degrees in fevers, because of the increased 

elimination of heat which results from the profuse sweating 
and dilated blood vessels of the skin. The temperature 
begins to go down in fifteen minutes, and stays down for 
about six hours. The normal temperature is not affected, 
however. 

Action on the secretions: The salicylates increase the 
secretion of sweat especially. About fifteen minutes to a 
half hour after a dose of one of the salicylates is given, 
the patient is usually covered with profuse per¬ 
spiration. 

Action on the circulation: The salicylates usually make 
the pulse somewhat faster and stronger at first, by increas¬ 
ing the contractions of the heart muscle and contracting the 
blood vessels. 

With larger doses, the contractions of the heart muscle 
are soon weakened and the pulse becomes slower and weaker. 


SALICYLIC ACID 


Excretion 

The salicylates are eliminated from the body as salicyluric 
acid, mainly by the urine; usually in several hours. Some of 
the drug is also excreted in the perspiration, milk and bile. 

Poisonous Effects 

Large doses of salicylates often cause quite alarming 
symptoms, especially if used for a long time, but they are 
rarely fatal. The symptoms resemble those of quinine 
poisoning. 

Symptoms. —Overdoses of salicylates cause the follow¬ 
ing symptoms: 

1. Buzzing and noises in the ears, and a feeling of full¬ 
ness in the head. 

2 . Deafness. 

3. Dimness of vision. 

4. Profuse perspiration. 

5. Feeling of warmth all over the body. 

6 . Occasionally nausea and vomiting. 

In severe cases besides these symptoms there are usually: 

7. Dyspnea, rapid, irregular, deep and labored breathing. 

8. Collapse (slow, weak pulse, subnormal temperature, 
cold, moist skin, etc.). 

9. Unconsciousness. 

10. Occasionally the patient becomes delirious or even 
maniacal, and he often seems to see various objects about 
him (hallucinations of sight) or he seems to hear voices 
(hallucinations of hearing). 

Death has rarely resulted from salicylate poisoning. 

Treatment. —1. If the drug is stopped, the symptoms 
usually disappear in a few days or a week. 

2 . Caffeine, strychnine, or other heart stimulants are 
usually given, if the pulse is weak. 

Administration 

Salicylic acid or the salicylates, are best given in capsules, 
tablets or in a small quantity of milk or syrup, about an 
hour or two after meals. 

They are best given with sodium bicarbonate to overcome 
the pain in the stomach, or the nausea and vomiting which 
may result from the rapid formation of salicylic acid in the 
stomach. 

Preparations 

Salicylic Acid; dose 5 to 30 grains. 

This is more readily dissolved in hot water or in a solu¬ 
tion of boric acid or borax. 

Sodium Salicylate; dose 5 to 30 grains. 


SALINE BATHS 


This is more soluble than the salicylic acid and is not so 
apt to upset the stomach. 

Lithium Salicylate; dose 5 to 30 grains. 

Ammonium Salicylate; dose 5 grains. 

Strontium Salicylate; dose 15 grains. 

Oil of Wintergreen (Oleum Gaultherise); dose 5 to 15 

minims. 

This is a volatile oil obtained by distilling Gaultheria 
procumbens or wintergreen. It contains 90 per cent, of 
methyl salicylate and is given in an emulsion or in capsules. 
It acts like the salicylates, but it occasionally causes nausea 
and vomiting. 

Methyl Salicylate; dose 5 to 15 grains. 

This is artificial oil of wintergreen. It is contained in oil 
of wintergreen and oil of sweet birch. 

Salicin; dose 5 to 30 grains. 

Salicin is a glucoside obtained from the bark of various 
species of willow and poplar trees. It is changed to salicylic 
acid in the body and it then produces the same effects. 

It lias a very bitter taste and is not as reliable in its 
action as the other preparations. 

Salol (Phenylis Salicylas) ; dose 5 to 30 grains. 

Salol is a tasteless powder which is decomposed in the 
intestine, into salicylic and carbolic acids. The salicylic 
acid is absorbed into the blood from the intestines, and it 
then produces the same effects as the salicylates. It is fre¬ 
quently used as an intestinal and urinary antiseptic. Symp¬ 
toms of carbolic acid poisoning occasionally result from the 
carbolic acid which is formed in the intestines. 

Aspirin (Acidum Acetylsalicylicum) ; dose 5 to 15 grains. 

This is a compound made chemically from salicylic acid. 
It is absorbed in the intestines and then acts like salicylic 
acid, but because it is very slowly absorbed, its effects are 
more lasting. 

Novaspirin; dose 5 to 15 grains. 

It acts like aspirin but is said not to upset the stomach. 

SALINE BATHS 

These are artificially prepared sea-water baths. 

Composition of the Bath.— Eight pounds of sea-salt to 
thirty gallons of water, or by using five to eight pounds of 
ordinary salt, practically the same effects may be produced. 
For partial baths use four ounces to one quart. 

The temperature of the hath is usually 70° F. The dura¬ 
tion is usually ten minutes, with friction during and after the 
bath. 

Effects of the Bath.—Sea-water feels much warmer than 
fresh water because the salts present irritate or stimulate 


SALINE DIURETICS 


the nerves in the skin and so hasten the reaction, or, the 
increased flow of blood in the skin and the feeling of warmth 
and comfort. This makes it possible to give the saline bath 
two or three degrees lower than that of the fresh water 
bath usually tolerated by the patient, so that both the desired 
circulatory reaction and the tonic effects of the thermic 
reaction are produced. The usual precautions are taken to 
avoid chilling or exhaustion. After the bath the patient 
should be wrapped in a warm sheet and brisk friction applied. 

SALINE DIURETICS 

Action on the kidneys: The effect of the saline diuretics 
on the kidneys is to increase the flow of urine, and results 
from their absorption. They increase the salt concentra¬ 
tion of the blood, and therefore its osmotic power. As a 
result, fluid is withdrawn into the blood from the tissues, 
and the fluid content of the blood is increased. This excess 
of fluid is then eliminated by the kidneys, thus increasing the 
secretion of urine. 

Administration 

The saline diuretics should be given well diluted in the 
morning when the stomach is empty. 

Preparations 

Potassium Acetate; dose io to 60 grains. 

Potassium Bitartarate (Cream of Tartar); dose io to 60 
grains. 

It is usually given in hot water, flavored with lemon juice. 

Potassium Citrate; dose io to 20 grains. 

This is not as unpleasant to take as the other potassium 
salts. It increases the secretion of sweat (diaphoretic action), 
as well as the secretion of urine. 

Solution of Potassium Citrate; dose 4 to 8 drams. 

This contains about 8 per cent, of potassium bicarbonate, 
and about 6 per cent, of citric acid. 

Effervescent Potassium Citrate; dose to 1 dram. 

This consists of potassium citrate 20 per cent., potassium 
bicarbonate and sugar. 

Effervescent Draught. 

This is made by adding 1 ounce of potassium bicarbonate 
to 1 ounce of lemon juice. 

Other potassium salts which are occasionally used as 
diureticj, are potassium bicarbonate, potassium carbonate, 
potassium chlorate and potassium sulphate. 

Sodium Acetate; dose 10 to 60 grains. 

Lithium Benzoate; dose 5 to 15 grains. 

Lithium Carbonate j dose 5 to 15 grains. 


SALINE PURGATIVES 


Lithium Citrate; dose 5 to 15 grains. 

Effervescent Lithium Citrate; dose 1 to 2 drams. 

This contains citric acid, lithium carbonate, sodium bicar' 
bonate and sugar. 


SALINE PURGATIVES 

Saline purgatives are inorganic (mineral) salts used as 
purgatives. They are all combinations of alkalies with 
acids. Only those salts are used which are not readily ab¬ 
sorbed. The saline purgatives all act on the entire intestine. 

Action 

Locally: The saline purgatives produce no effect. 

In the mouth: Most of the saline purgatives have a harsh, 
unpleasant bitter taste. 

In the stomach: They often produce nausea and vomiting. 

In the intestines: They produce frequent fluid stools 
accompanied by griping. 

Since the withdrawal of fluid from the tissues takes con¬ 
siderable time, bowel movements from concentrated salt 
solutions may occur only after ten or twenty hours. On 
the other hand, dilute solutions, because they are not absorbed, 
but merely distend the intestines, usually induce much more 
rapid effects. 

The saline cathartics are particularly valuable in cases 
where there is a great deal of fluid in the tissues (edema), 
for example, to reduce edema of the legs in nephritis, or to 
reduce ascites (fluid in the abdomen). In such cases they 
withdraw the fluid from the tissues into the intestines, and 
the frequent movements of the bowels which result, elimi¬ 
nate this excessive fluid, relieving the edema or the 
ascites. 

Saline cathartics are also given to reduce blood pressure, 
because they withdraw fluid from the blood. By lessening 
the total quantity of blood in the body, blood pressure is 
reduced. 

The saline cathartics should not be given in cases where 
there are ulcers or inflammation in the intestines, as they 
may aggravate this condition. 

A small portion of each dose of some of the salines is 
absorbed, and acts on the kidneys as a diuretic, increasing 
the flow of urine. 


Administration 

The saline cathartics are best given well diluted, preferably 
in the morning, when the stomach is empty. They move the 
bowels in a few hours. 

To relieve edema they should be given in a concentrated 


SALINE PURGATIVES 


solution, since more fluid is thus removed, and the effect 
is more prolonged. 

The preparations of the saline purgatives are best given 
in cold seltzer or vichy. If they are given hot, the addition 
of io or 15 drops of tincture of ginger makes them taste 
more agreeable. They should not be given stronger than 
5 to 10 per cent, solutions. 

Preparations 

Sodium Sulphate (Glauber’s Salt); dose V2 dram to 1 
ounce. 

This is soluble in 3 parts of water. This is best given 
in solution not stronger than 5 to 10 per cent. 

Sodium Phosphate; dose 15 grains to 1 ounce. 

This is soluble in 6 parts of water. It is best given in 
milk, not stronger than 5 to 10 per cent, solutions. 

Potassium Sulphate; dose 15 to 60 grains. 

Potassium Bitartrate (Cream of tartar); dose 15 to 60 
grains. 

Potassium and Sodium Tartrate (Rochelle Salt); dose 
2 to 4 drams. 

This is soluble in 1parts of water. It tastes pleasanter 
than Epsom salts. 

Magnesium Oxide, Calcined Magnesia, or Light Mag¬ 
nesia; dose 1 dram. 

Effervescent Preparations 

These preparations of the salts form gas (effervesce) 
when dissolved in water. 

Seidlitz Powder (Pulvis Effervescens Compositus); 

This is made up in two powders: 

1. The powder wrapped up in blue paper contains: 

Sodium Bicarbonate grs. xl 

Rochelle Salt 3 ii 

2. The powder wrapped up in white paper contains: 

Tartaric Acid grs. xxv 

A seidlitz powder should always be administered at the 
bedside. Each powder should be dissolved in half a glass 
of water, the two solutions mixed and the mixture given to 
the patient. 

The combination of the tartaric acid and sodium bicar¬ 
bonate forms carbon dioxide gas, which causes the effer¬ 
vescence. Seidlitz powder is often given to distend the 
stomach, for diagnostic purposes. 

Solution of Citrate of Magnesia; dose 5 to 12 ounces. 

This is a solution of magnesium citrate and citric acid, 
to which potassium bicarbonate is added. It is usually kept 


SALVARSAN 


in tightly closed bottles, and effervesces when it is poured 
in a glass. 

Effervescent Magnesium Sulphate; dose 4 to 8 drams. 

This contains Epsom salt, sodium bicarbonate, tartaric and 
citric acids. The mixture effervesces when mixed with water. 

Effervescent Sodium Phosphate; dose 2 drams to 2 ounces. 

This contains sodium phosphate, sodium bicarbonate, tartaric 
and citric acids. The mixture effervesces when dissolved in 
water. 

Effervescent Lithium Citrate; dose 1 to 2 drams. 

This contains lithium citrate or lithium carbonate, sodium 
bicarbonate and citric acid. 

All the effervescent preparations, if not already in solution, 
should be given in a tumblerful of water. 

See Cathartics. 


SALINE SOLUTION 

There is some confusion in the terminology of the saline 
solutions. There is (1) the Physiological Salt Solution, 
which is a 0.6 per cent, solution; and (2) the Normal Salt 
Solution, which is a 0.9 per cent, solution. Unfortunately 
the term Normal is frequently applied, indiscriminately, to 
each of these solutions; hence it is advisable to ascertain 
which of the two is meant before proceeding to make the 
solution. The 0.6 per cent, solution is roughly made by 
adding one and a half drams of salt (Sodium Chloride) 
to a quart of water that has been boiled; the 0.9 per cent, 
solution is made by adding two drams of sodium chloride 
to a quart of water that has been boiled. 

SALIPYRIN 

See Antipyrin. 

SALOCOLL 

See Phenocoll. 

SALOL 

See Salicylic Acid. 

SALPINGITIS 

See Fallopian Tubes. 

SALVARSAN 

Salvarsan, arsphenamine, arsenobenzol, or “ 606 ” is a 

complex organic arsenic salt. It is a yellow powder which 
comes in a sealed glass tube together with nitrogen gas, 
since it is readily changed by the oxygen of the air. 

Action 

Salvarsan is a specific for all stages of syphilis. It com¬ 
bines with, and destroys, the Spirochaeta pallida, the organism 


SANDBAGS 


which causes the disease. In a few weeks after the admin¬ 
istration of the remedy, there is a remarkable and prompt 
disappearance of all the symptoms of the disease, such as 
the initial sore, the rash, the mucous patches and the other 
manifestations. The patient is not considered cured, how¬ 
ever, until the examination of his blood shows that he 
is free from the disease. The administration of the remedy 
is therefore repeated at weekly intervals. 

Salvarsan has also been used with success in the treatment 
of malaria and other infectious diseases resulting from 
the circulation in the blood of parasitic organisms, such as 
those of relapsing fever, frambesia, etc. 

Neosalvarsan is not as efficient as salvarsan, therefore it 
must be given in larger doses, but it is easier to administer. 

Idiosyncrasies 

1. Symptoms of arsenic poisoning may result. 

2. The rash may temporarily become more intense, there 
may be a rise in temperature, headache and ringing in the 
ears (Herxheimer’s reaction). 

Administration 

1. Salvarsan is usually given by direct injection into the 
veins, as an intravenous infusion. The remedy must be 
very carefully neutralized with an alkali, such as potas¬ 
sium hydroxide, and then dissolved in about 250 to 300 c.c. 
of sterile, distilled water or saline solution, and the resulting 
solution is then allowed to slowly run into the veins. 

It is also given by deep injections into the muscles. 

2. Neosalvarsan is dissolved in sterile, distilled water, 
about 25 c.c. being used for every 0.1 gm. of the drug. 

It is given like salvarsan, by injection into the veins, or 
into the muscles. 

Neosalvarsan is only half as strong as salvarsan. It 
does not have to be neutralized with an alkali. 

Preparations 

Salvarsan or “ 606 ” (Arspbenamine, or Arsenobenzol); 

dose 5 to 10 grains. 

This contains about 31 per cent, of arsenic. 

Neosalvarsan; dose 10 to 14 grains. 

See Arsenic. 

SANDBAGS 

Sandbags of different sizes are used extensively for re¬ 
straint or support in maintaining certain positions. They 
are also used to limit motion and relieve pain due to the 
twitching of muscles. They are sometimes covered with 
stout ticking but are more satisfactory when covered with 
rubber as they are easily cleansed and disinfected. When 
covered with ticking, washable covers must be provided. An 


SANTONICA 


extremity or other part of the body may be restrained by 
covering it with a towel and placing sandbags over the ends 
of the towel and fitting snugly against both sides of the 
limb. This will prevent both lateral and upward movement. 

SANTONICA (LEVANT WORMSEED) 

Santonica or Levant wormseed is the dry unopened 
flower heads of the Artemisia pauciflora, a plant growing in 
Asia Minor. Its active principle is a crystalline substance 
called santonin, though it also contains a similar substance 
called artemisin and a volatile oil, cineol. 

Action 

Santonin has a bitter taste and is partly dissolved in the 
stomach. Here some of it is absorbed into the blood. Most 
of the santonin then passes out into the small intestine, 
where it destroys round worms, or ascaris lumbricoides. 

The absorption of some of the santonin causes, in many 
cases, a very characteristic and peculiar disturbance of 
vision known as xanthopsia, or “yellow vision.” 

At first all objects seem to have a blue color, but this 
effect lasts for a very short time, and is soon followed by a 
condition where all objects seem to have a yellow tint; 
thus, blue seems green; and violet cannot be seen at all. 
This condition lasts for several hours and is probably due 
to a direct poisonous effect on the retina. Occasionally 
there are also disturbances of the sense of taste, smell, and 
hearing. 

Santonin is excreted by the urine, to which it gives a 
characteristic yellow or reddish color. 

Poisonous Effects 

Overdoses of santonin not infrequently cause poisonous 
symptoms, especially in children. • 

Symptoms.—i. “Yellow vision.” 

2. Twitchings of the muscles of the head. 

3. Rolling of the eyes, and grinding of the teeth. 

4. Various movements of the head, forward and back¬ 
ward, and from side to side. These symptoms are soon 
followed by: 

5. Convulsions. 

6. Slow, irregular breathing, especially during the con¬ 
vulsions. 

7. Collapse (slow, weak pulse; moist, cold skin; dilated 
pupils, etc.). 

8. Occasionally nausea and vomiting, or loss of speech 
(aphasia), occur. 

Treatment.—The stomach should be washed out; emetics 
and cathartics are given. The convulsions are treated with 
chloroform or ether. 


SANTONIN 


Preparation 

Santonin, the active principle, is the drug which is prin¬ 
cipally used. Dose to 5 grains. 

For a child 2 years old V\ of a grain should be given. 

See Anthelmintics. 

SANTONIN 


See Santonica. 


SAPONINS 


Saponins are glucosides which have some of the properties 
of soap; that is, they foam when mixed with water. They 
are found in a number of plants such as sarsaparilla, quillaja 
bark, etc. They are not absorbed, but merely act locally by 
injuring the tissues with which they come in contact (irritat¬ 
ing). When given internally they cause nausea, vomiting and 
diarrhea. Many drugs produce these effects because of 
the saponins which they contain. 

SAPREMIA 


See Sepsis. 


SARSAPARILLA 


Sarsaparilla is obtained from the roots of Smilax officin¬ 
alis, and other varieties of smilax. Its active principles are 
soapy glucosides (saponins). 

Action 

Sarsaparilla is used principally to improve the nutrition 
of the body (alterative). It is said to increase the perspira¬ 
tion. In large doses it causes vomiting and diarrhea. It 
was formerly used a great deal in the treatment of the 
third stage of syphilis, chronic rheumatism, etc. It is occa¬ 
sionally used as a drink. 

Preparations 

Fluidextract of Sarsaparilla; dose 1 dram. 

Compound Fluidextract of Sarsaparilla; dose 1 dram. 

This contains sarsaparilla, licorice root, sassafras and 
mezereum. 

Compound Syrup of Sarsaparilla; dose y 2 to 1 ounce. 

This is an excellent vehicle for potassium iodide. 


SAUTEING 


See Food, Preparation of. 

SCABIES 

See Skin Diseases. 

SCALDS 


See Burns. 

SCAMMONY 

Scammony is the dried milky juice (resin), obtained from 
the root of the Convolvulus scammonia, a vine growing in 
Syria. Its active principle is jalapin, a resinous substance. 
Scammony is used principally as a drastic cathartic. 
Preparation 

Resin of Scammony; dose 3 to 8 grains. 


SCHICK TEST 


SCARLET FEVER, NURSING IN 

Isolate the patient, and reserve the bathroom if possible. 
Everything coming in contact with the patient must be 
kept separate. All soiled clothing, etc., must be placed at 
once in a disinfectant, and all gauze and discharges burned. 
The room should be kept at a temperature of about 7o° F., 
and be well ventilated; but the patient must be kept warm. A 
warm bed bath should be given daily until three or four 
days after the temperature is normal, then a daily tub bath. 
Water absorbed assists the kidneys and aids desquamation. 
Extra baths may be given for extreme restlessness or for 
intense rash. Oil rubbed in the body aids desquamation. 
Keep a normal case in bed for three weeks; such a case is 
considered free from contagion after thirty days. Watch 
the urine closely as to character and amount. Any rise in 
temperature, earache, enlarged cervical glands, or scanty 
urine should be reported to the physician at once. 

Diet for normal case: 

First week, or until temperature is normal: Milk, fruit 
juice, water. 

Second week, add toast and cereals. 

Third week, add soup and vegetables. 

Fourth week, meat may be given to adults once each day. 

See Infectious Diseases, Course of. 

SCHAEFER’S METHOD OF ARTIFICIAL RESPIRATION 

See Artificial Respiration. 

SCHICK TEST 

In order to determine whether a prophylactic dose of 
antitoxin is necessary in case qf exposure to diphtheria 
Schick has devised a simple skin test for detecting the pres¬ 
ence of natural antitoxin in the blood. A minute amount 
of toxin (about one-fifth of the minimum lethal dose for a 
guinea pig) is injected intradermically. If the person receiv¬ 
ing the toxin possess an amount of antitoxin equal to at 
least one-thirtieth of a unit in each cubic centimeter of 
blood the injected toxin is neutralized and no reaction 
appears; if, on the other hand, he has no antitoxin, the 
toxin acts as an irritant to the skin and in from twenty to 
forty-eight hours produces a small inflamed area. This 
positive reaction indicates that the person has no natural 
antitoxin and therefore that he is susceptible to the disease; 
conversely, a negative reaction indicates that an individual 
has in all probability sufficient natural antitoxin to protect 
him, even in case of exposure, and a prophylactic dose is 
unnecessary. 


SC ILL A 


SCILLA 

See Squill. 

SCOPARIUS (BROOM TOPS) 

Scoparius is obtained from the dried tops of the Cytisus 
scoparius, or common broom plant, which grows in Europe 
and the United States. Its active principles are a liquid 
alkaloid, sparteine, and a neutral substance, scoparin. Its 
diuretic action is due to the scoparin. 

Action 

The principal action of scoparius is to increase the flow 
of urine, but its effect is not very marked, however. 

Preparations 

Scoparius is given in the form of a decoction, made by 
boiling about half an ounce of broom tops in water, to 
make up half a pint. About one ounce of this decoction is 
given every 2 or 3 hours. 

See Sparteine. 


SCOPOLA 

Scopola is obtained from the underground stems of the 
Scopola atropoides, a plant which grows on the hills of 
central and southern Europe. It acts like atropine but has 
a soothing effect on the brain. 

Preparations 

Extract of Scopola; dose 14 to V2 of a grain. 

Fluidextract of Scopola; dose 1 to 2 minims. 

Scopolamine hydrobromide is the same as hyoscine hydro¬ 
bromide and is given in doses of 1/200 to 1/100 of a grain. 

SCOPOLAMINE 

See Hyoscine, Hyoscyamine, and Scopola. 

SCOPOLAMINE MORPHINE ANESTHESIA 
(Twilight Sleep) 

Hyoscine or scopolamine is given together with morphine 
to produce a state of mild unconsciousness or anesthesia, so 
as to enable the performance of painless operations. It 
may be used alone or as a preliminary to a general anesthetic. 

It has been used, however, for painless childbirth. The 
method, which is commonly known as “twilight sleep,” con¬ 
sists in inducing the following effects: 

1. A drowsy state in which the consciousness, as well as 
the sense of pain, is lessened. 

2. A loss of memory for pain. 


SCURVY 


Method of Administration 

The desired condition is brought about by giving a dose 
of hyoscine with morphine as soon as labor pains start. The 
hyoscine alone is then repeated every hour; but each time in 
a smaller dose. 

The effect of the drug is enhanced by darkening the 
room and maintaining calm and quiet surroundings. 

To determine whether the desired effects are obtained, 
the nurse should test the patient’s memory about every half 
hour, throughout the administration: by showing the pa¬ 
tient the same object at frequent intervals. When the 
patient does not remember the object seen, the desired 
effect is obtained. The same object should not be shown 
too often, however, as the test may then become unreliable. 
During treatment, the patient should be carefully watched, 
for symptoms of collapse and poisoning (atrop’ne poisoning). 
Many patients are delirious throughout the treatment, al¬ 
though they do not remember the pains. 

SCURVY 

Scurvy, like rickets, is a constitutional disease, due to a 
disturbance of the nutrition, but the disease, while often 
associated with, is not synonymous with rickets. 

Factors Inducing Scuivy. —Consensus of opinion proves 
that scurvy is caused by errors in diet; not temporary errors, 
but errors which have continued over an appreciable length 
of time. In the various investigations and analyses of the 
diets of a vast number of cases the trouble is now believed 
to be due to a lack of some essential element in the food, and 
not to any foreign element. 

Scurvy in Breast-fed Babies. —Breast-fed babies occasion¬ 
ally develop scurvy, but it is by no means so common in 
these infants as in those receiving an artificial food, whethei 
that food consists of a milk formula or a proprietary food 
Science has proved that while the heating of milk, as ir 
pasteurizing and sterilizing and boiling, may be one of th<| 
causes of this disease, it is not the only one, since babies re 
ceiving raw milk likewise develop scurvy. 

Lack of Vitamines. —Recently it has come to be believer 
that possibly the lack of vitamines in diet may give rise t< 
this trouble. These substances are extremely sensitive t< 
heat, and when babies are fed upon cooked milk and do no 
receive other food in which the vitamines are not destroyec 
by heat, they are apt to develop scurvy. It has been know: 
for a long time that fresh fruit juices and vegetables con tail 
antiscorbutic elements, and for this reason they have beei 
included in the diet of children and adults who are suffer 
ing from scurvy. 




SECUNDINES 


Treatment. —If the baby is fed on breast milk, the diet of 
the mother should be changed to increase the nutrients in 
the milk. When proprietary foods are used they should 
either be made up with milk or should be eliminated in favor 
of a modified milk formula. The latter should be pasteurized 
when necessary, but as low a degree of heat used as possible 
to bring about the desired result. Orange juice is the 
simplest and most available of substances containing the 
necessary properties by which scurvy is relieved. This may 
be added to the diet after the baby is a few months old, 
the dose being one ounce per day, given one hour before 
the milk feeding when the stomach is more or less empty. 
It may be diluted with water and slightly sweetened if the 
baby will take it better so. Orange peel contains the anti¬ 
scorbutic properties and has the advantage of being cheaper 
than oranges. 

Antiscorbutic Foods. —Since scurvy yields readily to the 
action of the antiscorbutic properties in orange and lemon 
juice, it is not necessary to give vegetables to babies. How¬ 
ever, in certain cases a boiled or baked Irish potato finely 
mashed and given in doses of one to two tablespoonfuls a 
day results in a rapid recovery. 

SECUNDINES 

See After-birth. 

SEIDLITZ POWDER 

See Saline Purgatives. 

SENEGA 

Senega is obtained from the root of the Polygala senega, 
or senega snake root, a plant growing in the middle and 
southern United States. 

Uses 

Senega is used principally as a stimulating expectorant 
and somewhat as a diuretic. 

Preparations 

Fluidextract of Senega; dose io to 15 minims. 

Syrup of Senega; dose 1 to 2 drams. 

Senega is also contained in the compound syrup of squill. 

SENNA 

Senna is obtained from small dried leaves of an oriental 
?hrub. The active principle of senna belongs to the same 
group of substances as aloin. 


SEPSIS 


Action 

Senna acts principally on the large intestine, producing in 
five hours after it is given, frequent watery stools, usually 
accompanied by severe griping pains. 

To overcome the griping, it is usually combined with other 
substances, especially carminatives. 

It is excreted in the urine. In nursing women it is 
excreted in the milk, and it will then act as a laxative 
on the nursing infant. 

Senna in small doses is often given to children as a 
laxative. 

Preparations 

Confection of Senna; dose i to 2 drams. 

Containing senna, cassia fistula, tamarind, prune, fig, sugar 
and oil of coriander. 

Compound Infusion of Senna (Black Draught); dose 1 

to 4 ounces. 

Contains senna, manna, magnesium sulphate and fennel. 

Syrup of Senna; dose 1 to 4 drams. 

Senna tea is a preparation often given to children. It is 
an infusion of senna leaves, made from a teaspoonful of 
leaves to a cup of water. 


SEPSIS 

Septicemia, Pyemia and Septic Intoxication.—Septicemia 

or acute general sepsis is the result of the entrance, growth, 
proliferation or general flooding of the blood stream with 
pyogenic organisms. 

Pyemia is septicemia in which the organisms have gained 
a foothold here and there in the tissues of the body in 
which they deposit colonies or suppurative foci of infection 
(abscesses) from which bacteria are from time to time 
poured into the blood stream. 

Septic intoxication or toxemia is due to the absorption 
of toxins from the suppurating wound or abscess. 

Sapremia is a general poisoning due to the absorption of 
poisons due to the action of putrefactive organisms on dead 
tissue. An example of this would be puerperal sepsis due 
to the action of organisms on a portion of the placenta 
allowed to remain in the uterus after childbirth. 

The organisms which most commonly cause septicemia are 
the streptococcus pyogenes, the staphylococcus aureus or 
albus, the pneumococcus, gonococcus, bacillus coli communis, 
bacillus pyocyaneus, and others. 

The symptoms usually begin on the third post-operative day 
with chilly sensations or a definite chill, headache, and back¬ 
ache, and the patient feels very miserable in general. The 


SEPSIS 


temperature rises to 102°, 105° or 107° F. The mouth is 
dry, the lips parched, the tongue coated and the patient is 
very thirsty. The high fever may be continuous but more 
often there are marked remissions, rising after a chill 
(probably due to a pouring out or flooding of the blood 
stream with fresh bacteria) and falling to or below normal 
during the cold sweats which occur. The pulse is rapid and, 
as the lining and muscles of the heart and blood vessels 
become affected, soft, small and easily compressible. As 
the kidneys become affected the urine is scanty. Red cells 
are destroyed causing the marked pallor, and bacteria plug 
the capillaries with emboli, forming petechial spots. While 
the patient’s resistance lasts there is a marked leucocytosis 
which falls as the general prostration increases. In fatal 
cases restlessness and delirium alternate with stupor which 
finally passes into coma before death. The local symptoms 
are pain and acute inflammation about the wound. 

Treatment and Nursing Care. —The local treatment con¬ 
sists in a thorough drainage, cleansing and irrigation of 
the wound or focus of infection. When the symptoms are 
due to toxemia they subside with the local treatment but 
when due to general sepsis they are not relieved by the local 
treatment. In septicemia and pyemia the prognosis is very 
grave but patients have recovered with proper treatments 
and skilled nursing care. Transfusions are given to supply 
antibodies and to increase the patient’s resistance. Hypo- 
dermoclysis and protoclysis are given to stimulate the heart, 
supply fluid to the tissues, relieve thirst, dilute the poisons, 
stimulate the kidneys and to flush the poisons and bacteria 
out of the system. Water is also given freely by mouth. 
Nourishing fluids are given by mouth or when nausea and 
vomiting prevent, nutrient enemata are given. Everything 
is done to keep up the patient’s strength and resistance and 
to cause the elimination of the poisons. Fresh air and 
sunlight are essential. Everything must be done to relieve 
discomfort—the headache is relieved by an ice-cap, the 
backache by massage and by rubbing with alcohol, chills by 
the application of external warmth, the high fever, restless¬ 
ness, delirium or stupor by cool sponging. The mouth is 
kept moist and clean, perspiration is removed by sponging, 
the gown and bed linen are kept dry and clean. 

Skilled nursing care will do much toward keeping up the 
patient’s strength and preventing him from being over¬ 
whelmed by the invasion of the bacteria. 

A patient with septicemia or pyemia should be isolated from 
other surgical patients and every precaution taken to prevent 
the spread of infection. The nurse must avoid or take great 
care of even the slightest abrasions which she, herself, may 


SERUMS 


have, for bacteria may enter by the most minute abrasion, 
even too small to be visible, and cause a general septicemia 
even before the local symptoms develop. 


SEPTICEMIA 

See Sepsis. 

SEPTIC INTOXICATION 

See Sepsis. 

SEPTUM DEVIATED 

See Nose. 

SEQUESTRUM 

See Osteomyelitis. 

SERUM SICKNESS 

See Anaphylaxis. 


SERUMS 


When a patient suffers from an infectious disease, and 
then recovers, the disease has been overcome by the forma¬ 
tion in the blood of antibodies against the causative agent 
of that particular infection. The patient is then said to 
have developed an active immunity against the disease, be¬ 
cause he himself has formed the antibodies. 

Similarly, when an animal is injected with bacteria or 
their poisonous excretions (toxins) in gradually increasing 
doses, the animal develops an active immunity against the 
injected bacteria or their toxins. The serum of such an 
animal can then be injected into patients to overcome 
a similar infection. As a result of the injection the patient 
becomes immunized against the disease. Immunity pro¬ 
duced in this way is called passive immunity because it was 
the result of antibodies formed in the blood of another 
animal. 

Serums are usually given hypodermically or intramuscu¬ 
larly; for immediate effect some are injected intravenously. 

A serum is the serum of an animal that has been immun¬ 
ized against a particular bacterium or its toxins. Serums 
are of two kinds: bacteriolytic, and antitoxic. 


Bacteriolytic Serums 

A bacteriolytic serum is the serum of an animal that 
has been immunized against particular bacteria. The horse 

is the animal commonly used for the manufacture of serums 
since the largest quantity of serum can be obtained from 
this animal. 


Method of Manufacture 




A horse is injected with a small dose of a solution of the 
particular bacteria against which the serum is desired. The 


SERUMS 


horse then becomes ill and has a rise of temperature, which 
disappears in a few days. When the animal is well again, the 
injection is repeated, but with a larger dose; which now 
does not produce such severe symptoms. 

The injections art repeated until the animal can stand 
injections of large doses of the bacteria without any symp¬ 
toms being produced. The horse is then immune against 
these particular bacteria, and his serum contains antibodies 
against the bacteria with which he was injected. The animal 
is then bled from the jugular vein, the blood is allowed to 
clot, and the serum is removed under strictly aseptic pre¬ 
cautions. This serum, when injected into patients suffering 
from an infection produced by the same bacteria, neutralizes 
their poisonous effects; the antibodies of the serum combin¬ 
ing with the bacteria. 


Preparations 

Antistreptococcus Serum, used in the treatment of septi¬ 
cemia, erysipelas, scarlet fever. 

Antistaphylococcus Serum, used in the treatment of sepsis 
caused by Staphylococci. 

Antipneumococcus Serum, used in the treatment of pneu¬ 
monia. 

Antigonococcus Serum, valuable in the treatment of gonor¬ 
rheal joints. 

Antidysenteric Serum. 

Antimeningococcus Serum; it is injected in 15 to 30 
c.c. doses into the spinal canal, after the same amount of 
fluid has been withdrawn from the canal. 

Antityphoid Serum. 

Antitoxic Serums 

An antitoxic serum is the serum of an animal that has 
been immunized against the poisonous excretions (toxins) 
of bacteria, but not against the bodies of the bacteria 
themselves. 

Antitoxic serums are prepared in the same way as anti¬ 
bacterial serums but the animal is repeatedly injected with 
a filtrate of a bouillon culture of the bacteria obtained 
through a Berkefeld filter. This filtrate contains only the 
toxins of the bacteria, but not their bodies. 

Preparations 

Diphtheria Antitoxin Serum 

This is the serum of a horse that has been immunized 
against the toxin of the diphtheria bacilli. It contains anti¬ 
bodies against the diphtheria toxin. When the serum is 
injected into a patient suffering from diphtheria, the anti- 


SHOCK 


bodies combine with the diphtheria toxin, thereby neutralizing 
the symptoms of the disease. 

Diphtheria antitoxin is the most efficient serum which is 
used at the present time. The disappearance of the mem¬ 
brane in the throat, and the clearing up of all the toxic 
symptoms result in one to two days after the injection. 

It is usually given in doses of 5000 to 10000 units intra¬ 
muscularly, and in severe cases intravenously (an antitoxic 
unit is the amount of antitoxin that will immunize a guinea 
pig weighing 250 gms. against 100 times the fatal dose of 
diphtheria toxin). It should be repeated every 12 hours 
until all the symptoms disappear. It should always be 
given early in the disease. In the later stages the diphtheria 
toxin may have already combined with the nerve cells and 
complications may then result, but no case is hopeless. 

Diphtheria antitoxin is also given in doses of 500 to 1000 
units to those who are exposed to diphtheria cases, to 
prevent them from contracting the disease (thus immuniz¬ 
ing them). 

Tetanus Antitoxin 

This is the serum of a horse that has been immunized 
against the toxins of the Tetanus bacilli. 

It is given in doses of 3000 to 20000 units every 4 to 8 
hours. As an immunizing dose about 1500 units are given. 

SHERRY 

See Alcohol. 

SHOCK 

Causes of Shock. —Predisposing Causes. —Shock is much 
more apt to develop in the old, weak, or poorly nourished, 
in patients with a highly impressionable nervous system, and 
in those exhausted by either mental or physical strain or 
poisoned by alcohol or other drugs. 

Exciting Causes. —Any agent which produces a violent im¬ 
pression on the central nervous system or any agents, such as 
ether or chloroform, which are highly toxic and cause marked 
depression may produce shock. 

Common Causes. —1. Violent emotions such as grief or 
fear, both of which cause marked depression of the whole 
nervous system and therefore of the vital centers. 2. Ex¬ 
treme pain such as may precede or follow an operation or 
accompany severe burns, crushing injuries or laceration and 
mangling of the tissues by machinery. 3. Operations or 
injuries with prolonged exposure of the patient with loss of 
body heat. 4. Exposure or rough handling of the abdominal 
viscera in operating. 5. Operations or injuries accompanied 
by severe hemorrhage or injury to nerve trunks. 6. Extensive 


SHOCK 


wounds in the skin. 7. Direct pressure over the heart and 
large blood vessels, and injuries to the larynx. 

Symptoms of Shock. — (Summary ).—Following an opera¬ 
tion (or injury) the symptoms to be watched for most 
closely are apathy, pallor, a pinched, drawn face, cold, 
moist, clammy skin, extreme weakness, a rapid, weak, 
irregular pulse, rapid, sighing, irregular respirations and 
lowered blood pressure. 

Treatment of Shock. — Prophylactic .—The treatment before 
an operation is extremely important, quite as important as 
that following, for it may prevent shock to a large extent. 
The need of a good night’s rest, of comfort, warmth, a 
cheerful, hopeful frame of mind, a body well nourished and 
tissues well supplied with water should always be remem¬ 
bered. 

Anoci-association in the Prevention of Shock .—The belief 
that shock is due to afferent impulses either psychic or 
traumatic in origin has led to the application of anoci-asso¬ 
ciation to prevent operation shock. Anoci-association means 
the exclusion of all harmful impulses, influences, or associa¬ 
tions. 

Before the operation, the harmful and depressing effects 
of anxiety, fear, and dread of pain are prevented by 
numbing the brain with hypodermic injections of morphine 
and scopolamine. Sometimes, during the operation—for in¬ 
stance, in exophthalmic goiter—the field of operation is 
blocked off and all pathways broken by injections of novo- 
caine, so that no harmful impulses reach the central nervous 
system from the injured tissues. Before closing the wound, 
quinine and urea hydrochloride are injected around the 
whole area so that for several days after the operation no 
impulses reach the brain from the injured tissues. 

During an operation the patient is kept well under the 
anesthetic to prevent harmful impulses reaching the brain. 
All bleeding, if possible, is completely checked. The opera¬ 
tion is performed with speed and the patient returned 
promptly to a warm bed. In an abdominal operation exposure 
is avoided, the contents are handled as little and as gently 
as possible and are protected with hot saline pads. 

After the operation the patient should be placed in the 
recumbent position, kept absolutely quiet and moved about 
as little as possible in order to relieve the work of the 
struggling heart. The room should be dark and no visitors, 
or talking, or noise of any kind, likely to disturb the patient, 
allowed. Morphine is usually ordered to prevent pain, one of 
the common factors in the development of shock. 

The patient’s head should be lowered by raising the foot 
of the bed or placing him in the Trendelenburg position in 


SILVER 


order to supply the anemic brain with blood and revive the 
vital centers. To further increase the blood supply in the 
heart and brain, the extremities may be bandaged—the arms, 
from the fingers to the shoulder; the leg, from the toes to 
the hips. 

No tight clothing or weight of bedding should be allowed 
about the chest as this would further embarrass the breathing. 

To prevent heat elimination and to raise the body tem¬ 
perature, heat in the form of extra blankets, hot-water 
bottles, and friction with a warm towel to the extremities 
should be applied. Friction with the warm towel stimulates 
the circulation, removes perspiration and dries the patient. 
(In treating an accident case for shock, never allow the 
patient to remain on the cold ground or floor even if 
warmly covered.) It is said that hot fluids by mouth have 
little effect, as they remain unabsorbed in the stomach, but 
that after reaction has set in they are valuable. 

To stimulate the heart, a mustard plaster or local heat 
is sometimes applied over the heart. Care must be taken not 
to oppress the chest as pressure on the chest will increase 
the shock. 

To increase the volume of blood, to increase the force of 
the heart and raise the blood-pressure, direct transfusions of 
blood or repeated intravenous infusions of hot normal saline 
solution, with or without adrenalin, may be given. 

Various stimulants —atropine, strychnine, whisky, caffeine, 
camphor, hot coffee (caffeine), and digitalis—are extensively 
used, but it is said that recent studies seem to contraindicate 
their use as they tend to stimulate consciousness or open up 
pathways for afferent impulses, thus intensifying shock 
(Hare). They are, however, valuable and are given in cases 
of extreme shock to ward off immediate death and revive 
the patient while other treatments are being prepared. When 
large or repeated doses of stimulants are given it is important 
to watch later for symptoms of cumulative poisoning. 

The treatments used to relieve shock are much the same 
as those used to relieve the effects of hemorrhage. 

See Hemorrhage, and Transfusion. 

SIDONAL 

See Piperazine. 

SILVER (ARGENTUM) 

Silver is a white, hard, glistening metal. The only salt of 
silver which is used to any extent in medicine is the silver 
nitrate. 

Chronic Silver Poisoning (“Argyria”) 

See Argyria. 




SIMMERING 


Uses 

Silver salts are used to check the growth of granulation 
tissue and to contract the mucous membranes of the eye, the 
nose, or the mouth when these are inflamed. 

The salts of silver are particularly valuable in the treat¬ 
ment of gonorrheal infection. They destroy the gonococci, 
the bacteria which cause the disease. 

Preparations 

Silver Nitrate; dose Vq to H of a grain. 

This is used in i to 2 per cent, solutions dropped in the 
conjunctiva of the eye, in newly born infants, to prevent 
gonorrheal ophthalmia. In other gonorrheal infections and 
for other conditions, it is used in much weaker solutions 
such as 1: 10,000 to 1: 1000. 

It forms an explosive compound with tannic acid. 

Moulded Silver Nitrate (Lunar Caustic). 

This comes in hard white sticks in the form of pencils. 
It is used to destroy excessive granulation tissue. 

Mitigated Silver Nitrate (Mitigated Caustic). 

This consists of one part of silver nitrate and two parts 
of potassium nitrate, fused into pencils like lunar caustic. 

Silver Oxide; dose J 4 to 2 grains. 


SIMMERING 

See Food, Preparation of. 


See 

See 

See 

See 


SINUS THROMBOSIS 

Brain, Abscess. 


Nose. 
Salvarsan. 
next page. 


SINUSITIS 
“ 606 ” 
SKELETON 
SKIN GRAFTS 


Skin grafts are of three kinds,—Thiersch, Reverdin, and 
Wolf. 

Thiersch Graft. —The superficial layers of the epithelium 
are shaved off with a razor and planted over the wound, the 
grafts being rather large in size. 

Reverdin Graft. —In this type small thin portions of the 
superficial layer of the skin are snipped off with scissors, and 
placed upon the granulating wound. 

Wolf Graft. —In this variety, the entire thickness of the 
skin is utilized as a graft, or it remains connected by a 
pedicle to that part of the body from which it was taken, 
and after the graft is firmly attached the pedicle is severed. 



The Human Skeleton. 
(Front View) 


(Courtesy of William Wood & Co., and John Bale Song Sr 
Danielsson, Ltd.) 













Vt*Tt»»X t 



The Human Skeleton. 

(Back View) 

(Courtesy of William Wood & Co., and John Bale Sons & 
Danielsson, Ltd.) 














SKIN DISEASES 


In all skin grafts, the nurse must not forget to keep the 
part quiet and warm. In removing dressings, the utmost care 
should be observed for fear of disturbing the graft itself, 
and as in all surgical procedures, the best aseptic technique 
should be maintained. 

SKIN DISEASES, NURSING OF 
General Directions for Adults 
Bathing 

Daily baths of soap and water are discontinued in the 
treatment of many skin diseases, such as Eczema. It is 
usually advisable to give one good cleansing bath before 
starting treatment. Gibb’s super-fatted cold cream soap 
should be used. After initial bath, daily Corn Starch baths 
can be given. Starch baths are advised primarily to relieve 
itching, but patients who are accustomed to daily bathing 
take great comfort in these baths when soap and water 
baths are forbidden. 

Directions for Starch Bath. —Use sufficient cold water to 
dissolve ^ box of corn-starch. To this solution add one 

quart of boiling water. If this solution does not form a 

jelly, cook on the stove until it does. Pour this mixture 

into bath tub warm water. Patient should remain in 

this bath about ten minutes. 

Removal of Crusts 

The skin must be carefully cleansed of all former treat¬ 
ments before applying new medicaments. 

Scales and High Crusts. —Remove gently all superficial 
crusts with a piece of absorbent cotton soaked in oil. 

Heavy Crusts. —Cover the crusts with a layer of vaseline 
and let this remain on for an hour and then gently lift the 
crusts with forceps. If this fails to dislodge crusts, apply 
a hot boric pack. Change the pack every five minutes or 
until the crusts are softened. After one complete removal 
of crusts the skin can be kept perfectly clean with the oil 
and starch baths. 

Application of Treatments 

Oozing Surface. 

A. IVashes: Shake the bottle or mixture well, pour a small 
amount of the solution into a saucer and with an old hand¬ 
kerchief sop on the wash, using a patting motion. When 
thoroughly dry, apply the ointment. 

B. Ointments: Cover well with ointment a piece of old 
pillow case about the size of the lesion and apply .the dressing 


SKIN DISEASES 


directly to the oozing surface. Fasten the dressing in place 
with a thin gauze bandage; never use plasters. 

Dry Surfaces. 

A. Washes applied as for oozing surfaces. 

B. Ointments applied directly to the lesions with a throat 
stick, using a sufficient amount to cover the surface. 

Crusted Scalps. —Part the hair and with the tip of the 
finger, rub the ointment into the scalp, about one-half an 
inch away, make another part and apply ointment in the 
same manner. Continue applying ointment until the scalp 
has been completely covered. Tie the hair up in a towel and 
let it remain over night. In the morning wash the hair with 
as hot water as patient can stand, using liquid soap. Unless 
liquid soap is used it is very difficult to remove grease from 
the hair. 

Directions for Making Liquid Soap. —'Shave a small cake 
of soap in very small pieces. Cover well with cold water 
and let it simmer on the stove until the particles are dis¬ 
solved. Add one pint of cold water and pour into a large¬ 
necked glass bottle. This amount is sufficient for several 
shampoos. 

Care of Infants and Children with Skin Diseases 

It is useless to apply treatments to infants or children 
without coverings, or to expect them to keep from scratch¬ 
ing without restraint. 

Bathing. —After initial cleansing bath, babies should be 
given at least one starch bath every morning. In extremely 
hot weather it is advisable to sponge the baby off with 
starch water every night. 

Application of ointments to the body are the same as in 
General Directions for Adults. 

Scalp and Face. —All tangled masses of hair and crusts 
must be removed before applying treatments. It saves a 
great deal of time if the hair is clipped very close to the 
head. During the acute stage of a disease, the scalp and 
face should be bandaged up day and night. 

Intertrigo (Scalded Buttocks) 

Place a pad under the buttocks and do not put on a diaper 
until the condition is perfectly healed. Change the pad as 
soon as baby soils it and apply a fresh layer of ointment. 
A most satisfactory ointment for the buttocks: 

Castor Oil 3 i, Ointment Zinc Oxide £i. Never use soap 
or water on the buttocks; clean with oil and when necessary 
wash off the buttocks with starch water. 

To Prevent Scratching: Starch baths at least once a 
day. General cleansing of skin once a day, and applica¬ 
tions of treatments twice a day. 


SKIN DISEASES 


Continual Use of Cuffs. 

Cuffs: Encircle the elbow with a piece of stiff cardboard 
that reaches from wrist to shoulder (cardboard used for 
ether cones), bandage on securely and pin to clothing one 
and one-half inch from the top. 

To Prevent Relapses: i. Careful investigation into feed¬ 
ing. 

1. In nursing babies on breast eliminate eggs from 
mother’s diet and cut down on milk and cocoa. 

2. Children on diet should not be given eggs in any 
form. Nurses should not change diet without first 
consulting the attending physician. 

2. Babies and children should be kept in as even a tempera¬ 
ture as possible. 

Guard against: 

a. Extremely cold weather. 

b. Long exposure to sun. 

c. Sharp winds. 

It is always advisable after an attack of eczema to apply 
a mild cream to the exposed parts before taking the child 
out doors. 

Eczema is not contagious. 

Impetigo Contagiosa. (Pus Infection of the Skin.) 

Treatment for adults and children alike. Impress upon 
patient and family that the disease is highly contagious and 
can be easily spread unless the following rules be enforced. 

Precautions .—All articles of clothing, bed linen, toilet 
articles, etc., belonging to the infected patient should be 
kept separate. The linen and towels should be boiled every 
day. 

Treatment .—Scrub with soap and water the infected spots 
twice a day, using a new piece of absorbent cotton for each. 
Do not touch the good skin when scrubbing the infected 
spots. Remove all crusts before applying the ointment. 
Bandage lightly the infected spots. Burn everything that 
cannot be boiled. 


Pediculosis 

Pediculosis Capitis (Head Lice and Nits). 

Soak the hair well with crude petroleum and then rub 
into hair (not the scalp) the following ointment: 

Acid. Salicylic. 3 ss 
Sulphuris Praecipitati 3 ss 
Petrolati M. 

Tie the hair up in a towel, let it remain over night and 
wash thoroughly with hot water and liquid soap. While the 


SKIN DISEASES 


hair is wet, comb out the nits with a very fine toothed comb. 
Petrolatum kills lice, and the Salicylic in the ointment 
dissolves the shells of the nits. This ointment should be 
applied every other night until head is clean. 

Pediculosis Vestimentorum. (Body Lice.) 

Body hairs should be carefully examined for nits. If 
nits are found, the hair must be either shaved or the oint¬ 
ment for nits be applied directly after a bath. Boil all the 
clothing that can be boiled, and press with a hot iron 
everything that cannot be boiled, paying especial attention 
to the seams of the clothing. One thorough treatment is 
usually sufficient. 


Scabies 

All the members of the family who suffer from itching, and 
all who have slept with a person thus affected, must be 
treated at the same time if the family wishes to secure 
definite cure and prevent reinfections. 

Treat as follows: A good hot bath, rubbing the body all 
over with soap and water for fifteen minutes. After the 
bath rub the ointment thoroughly into the body from chin 
to toes, back and front, especially between fingers and toes 
and under the arms. Do not rub ointment on the face or 
scalp. 

For adults repeat this treatment for three successive 
nights. Children and babies must be given treatments for 
five nights, because they are given weaker ointments. Babies 
under three can have ointments on face and scalp. 

Have freshly sterilized clothing ready for the patients to 
put on at the end of the treatment. Gather together all 
soiled bed clothes and underclothes and boil thoroughly for 
twenty minutes. Everything that cannot be boiled (as 
woolen blankets and outside clothing) must be pressed with 
a hot iron. Patients may complain of itching for several 
days after this treatment. This may be due to the strong 
ointments. A starch bath can be given to relieve this 
itching. If this itching continues for over a week, and 
there is no sign of dermatitis, treatment should be repeated. 
It should always be remembered that patients with light 
hair and fair skin cannot stand as strong ointments as dark 
haired patients with dark skin. 

For Adults: 

Naphtholis 3 ss 
Sulphuris Sublimati 3 i 
Balsam. Peruv. 

Vaseline aa 3 ss M. 


SKULL, FRACTURES OF 

The above ointment should be used in half-strength on 
children under twelve years. For babies under three years: 

Balsam. Peruv. 

Vaseline aa 3 ss M. 

Ring Worm of Scalp and Body 

This disease is easily spread from one child to another. 

Precautions. —i. The patient should sleep alone. 

2. Keep the patient’s clothing and towels and toilet 
articles away from other members of the family. 

3. In ring worm of the scalp a close fitting washable cap 
should be worn at all times. This cap should be changed 
and boiled daily. 

Treatment (Scalp ).—Clip the hair close to the scalp. Scrub 
the infected spots with soap and water twice a day and 
apply treatment directly to the spots. Pull daily from the 
infected areas all loose hairs. Body: Scrub the spot with 
soap and water and apply the ointment twice a day. The 
clothing should be sterilized daily. 

Varicose Ulcers 

Equipment .— 1. Wooden Blocks (5 inches by 8 inches). 

2. Bender Bandages. 

Old linen. 

Ointment. 

Safety pins. 

Place the two legs of the foot of the bed on the blocks. 
The dressing must be done twice a. day: at night after 
removing the bandages and in the morning before getting 
out of bed. Cover with ointment an old piece of pillow-case 
about the size of the ulcer. Place this over the lesion being 
careful not to get it over healthy skin. Beginning at toes 
make two turns and bandage up the leg with a circular 
motion. Every night on going to bed, remove the bandage 
and after doing the treatment pin a soft cloth around the 
leg. 


SKULL, FRACTURES OF 

Fractures of the skull may be divided into those of the 
vault and those of the base. Fractures of the vault may 
be simply fissures in the bone, or the bone may actually be 
depressed and splintered into several fragments. These 
cases are often accompanied by injuries to the blood vessels 
of the dura or pia mater, or by actual laceration of the brain 
substance. If it is a simple fracture, the treatment is that 
of elevating the depressed bone with forceps, or periosteal 


SMALLPOX 


elevators, and should some of the fragments be splintered 
very badly they may be removed with rongeurs or punch 
forceps. Occasionally it may be necessary to trephine. 

Fractures of the base are more serious because of the 
great danger of injuring the important brain structures 
in this location. As a rule, there is bleeding from the nose, 
sometimes the ears, and occasionally the pharynx. The treat¬ 
ment consists of absolute rest and quiet. The head should 
be slightly elevated and fixed between two pillows. If 
there is bleeding from the nose it is advisable to irrigate 
the nasal fossae with warm boric solution to prevent the 
clot from becoming foul through infection. In cases with 
bleeding from the ear, it is best to irrigate the external 
auditory meatus after which the canal should be packed 
with sterile cotton. The irrigations should be given about 
three times a day. Of course, the bowel movements should 
be free. If the patient is unconscious, about two drops of 
croton oil are placed upon the tongue to insure a thorough 
cleansing of the alimentary canal. Retention of urine is 
treated by catheterization. Some surgeons give all these 
cases urotropin in doses of from ten to twenty grains, three 
times a day, for it secretes an antiseptic into the cerebro¬ 
spinal fluid. If these fractures are accompanied by signs of 
brain injury, and of intracranial pressure from hemorrhage, 
operative interference is necessary, although the mortality is 
extremely high. 


SMALLPOX (VARIOLA) 

Smallpox is an acute infectious febrile disease, charac¬ 
terized by an itching eruption on the skin which passes 
through five stages, vis., macules, vesicles, pustules, crusts, 
and cicatrices, the last not always forming but permanent if 
formed. One attack usually insures immunity thereafter. 
The five forms of smallpox are: 

1. Varioloid, which is rarely fatal, and rarely leaves scars. 
A vaccinated person may have varioloid. 

2. Smallpox with discrete eruption, in which the pustules 
remain distinct; this is the most common form of true 
smallpox. 

3. Smallpox with confluent eruption, in which the pustules 
run together; pain and itching are more severe, and sepsis 
frequently occurs; this form is often fatal. 

4. “Black” Smallpox, with hemorrhagic eruption, i.e., 
with hemorrhage into the pustules; this form is nearly 
always fatal. 

5. Malignant or Toxic smallpox, with hemorrhage from all 
mucous membranes, and with extreme toxic symptoms; this 
is so rapidly fatal that the rash seldom appears. 


SMALLPOX 


The disease attacks people of all ages and conditions; it 
is transmissible even from the mother to the unborn infant. 

Vaccination was first introduced in England in 1796 by 
Dr. Edward Jenner, who found in his work as a country 
practitioner, that persons who had contracted cowpox from 
cows did not contract smallpox. From this beginning has 
been developed the modern system of vaccination, compulsory 
in many countries, and in most of the states of the United 
States, Massachusetts being the first to make it so in 1809. 

The safe and efficient method is by use of vaccine lymph 
carefully prepared in laboratories from calves. This elimi¬ 
nates any possible transmission of syphilis, tuberculosis, or 
leprosy, such as occurred with the arm to arm transplanting 
of virus in the earlier days. The vaccine lymph must be 
kept according to directions on the label attached in the 
laboratory; the scab resulting from its use should be not 
less than half of a square inch in size, except with infants, 
when the lesion is purposely made smaller. 

Immunity gained by vaccination has been said to last 
from seven to ten years; but it should not be depended on 
for more than one year. People should be vaccinated 
whenever exposed; infants should be vaccinated under six 
months of age. The power of vaccination to modify the 
severity of smallpox lasts, however, for many years. Before 
vaccination became generally practised, smallpox was a 
disease principally of childhood, while now the proportion 
of adults affected is greater. 

Course of the Disease: 

The incubation period, is ten to fourteen days, seldom 
longer. 

The period of communicability is from the appearance of 

the first symptoms to the complete disappearance of scabs 
and crusts and of discharge from any abscess. 

The symptoms come on suddenly, often beginning with a 
chill or convulsion; then follow severe headache, backache, 
pain in the extremities, nausea, vomiting, and sometimes 
delirium. Fever of 103° to 104° F. soon appears, and in 

many cases perspiration, marked thirst and constipation. 
There is sometimes a prodromal rash, resembling the rash 
of scarlet fever, on the lower part of the abdomen and 

the inner sides of the thighs. On the third day the eruption 
appears, usually beginning on the face near the roots of the 
hair; this is accompanied by heat and intense itching, and 

it spreads over the face, trunk, and extremities in a few 

hours. The initial fever and other symptoms now disappear, 
but the fever rises again, and delirium sometimes occurs, 
during the third or pustular stage of the erilption. The 
fever usually reaches its height about the ninth day, and 


SMALLPOX 


comes down by lysis. The scabs or crusts have formed 
and dropped off after three or four weeks. 

Complications to be watched for are: abscesses, cellulitis, 
empyema, myocarditis, nephritis, pharyngitis, pyemia, and 
septicemia. 

Nursing car© includes both the curative measures pre¬ 
scribed, and measures for preventing the spread of the 
disease. Vaccination of the patient is sometimes prescribed. 
The patient should lie in a soft bed in a well ventilated, 
darkened room. The itching may be much relieved by fre¬ 
quent sponging of the body with tepid water, and by 

application of oil or vaseline to the crusts. Pus may be 
cleansed from the pustules by sponging with an antiseptic 
solution. The patient’s wrists should be tied, if necessary, 
to prevent his scratching himself, as scratching increases 
the chances of scarring as well as of infection. His hands 
may be gloved and the gloves kept soaked with antiseptic 

solution. Special arrangement of light as red or other 
rays, and application of lint soaked in antiseptic solution 
or ointment to the face, are often prescribed to prevent 

pitting. It is important to watch for eruption on the 

mucous membrane of the mouth, nose, throat, and especially 
of the eyes; in the latter case serious injury to sight may 
result. In any case the eyes should be irrigated every 
two hours with the prescribed antiseptic solution, and 
the mouth should be frequently cleansed. The fluids 
and diet taken are, on the whole, as in any febrile dis¬ 
ease, details depending on the medical advice in each case. 
Medication excepting sedatives and cathartics is seldom 
prescribed. 

Prophylactic Measures are as follows: The infective 
agent of smallpox is not yet isolated, but is known to be 
present in lesions of the skin and mucous membranes of 
infected persons. The virus is transmitted by direct con¬ 
tact, by articles soiled with the discharge from lesions; it 
may be present in all body discharges including throat and 
nasal secretions as well as urine and feces; and it may be 
spread by flies. Isolation of the patient in a room screened 
from flies and free of vermin, and quarantine of exposed 
persons until they have been vaccinated, or for twenty-one 
days, should be insisted upon. Concurrent disinfection of 
all discharges, and of all utensils, bed-clothing, linen, and 
other articles used in the sick room; and on termination 
of the period of communicability, thorough cleansing and 
disinfection of the premises, are of greatest importance. 
Only the nurse and the doctor should come into direct 
contact with the patient. They should be vaccinated and 
should wear rubber gloves and suitable gowns for protec- 


SOLUTIONS 


tion, the nurse fastening muslin about her head or wearing 
a cap to entirely cover the hair. 

By observance of preventive measures, as vaccination and 
prophylaxis during care of patients, smallpox is fast being 
eliminated. Although the comparatively few cases now 
occurring are not dreaded as formerly, there are still more 
deaths than should occur from a preventable disease; and 
good nursing care is perhaps, excepting vaccination, the 
most important factor in making it altogether a disease of 
the past. 

See Infectious Diseases, Course of. 

SOAMIN 

See Arsenic. 

SOAP PLASTER 

See Lead. 

SODIUM 

See Alkalies; Iodides; Saline Diuretics; and Saline 
Purgatives. 

SODIUM NITRITE 

See Nitrites. 

SOLUTIONS 

A solution i9 a liquid containing particles of a solid, gas 
or another liquid, so finely divided, that this dissolved sub¬ 
stance cannot be seen, and the resulting fluid seems to be of 
one color and consistency. 

Solute and Solvent 

1. The dissolved substance is called the solute. 

2. The fluid in which a substance is dissolved is called 
the solvent. 

The solvent may be any fluid: water, alcohol, ether, etc. 
The solution is frequently called by the name of the solvent, 
such as an alcoholic solution, ethereal solution, etc. 

The Strength of the Solution 

The strength of the solution is the amount of dissolved 
substance which a given quantity of fluid contains; or the 
ratio of solute to solvent. It is customary to speak of the 
strengths of solutions in the following ways: 


SOLUTIONS 


1. The percentage method 

2. The ratio method 

3. The grains to the ounce method 

Percentage Method. —In this method we speak of the 

quantity of dissolved substance (solute), which is contained 
in ioo parts of fluid (solvent); the solvent is, therefore, 
always constant. For example, by a 5 per cent, silver nitrate 
solution we mean that 5.0 gms. of silver nitrate are dissolved 
in 100 c.c. of water. 

Ratio Method. —In this method we speak of the quantity 
of fluid (solvent), in which one part of the drug (solute) 
is dissolved. The quantity of solute is therefore always 
constant (one part). For example, a 1 to 500 solution 
means that 1 part of solute is contained in 500 parts of 
water, 1 gm. in 500 c.c. or 3 i in 500 drams. A 1 to 2,000 
solution means that 1 part of solute is dissolved in 2,000 
parts of water. A 1 to 30 solution means 1 part of sub¬ 
stance is dissolved in 30 parts of water, etc. 

Grains to the Ounce Method. —This method is gradually 
being abandoned and consists of expressing the number of 
grains of drug dissolved in an ounce of fluid. Like the 
percentage method the amount of solvent is thus always 
constant. 


Saturation 

It is not possible to dissolve any quantity of a drug in any 
fluid. A solution which contains as much of a solid, gas, or 
another fluid as it can possibly dissolve, is called a satu¬ 
rated solution. When more of the same substance is added 
to such a solution it does not dissolve, but falls to the 
bottom as a sediment, if it is heavier than the solvent, or 
rises to the top if it is lighter. 

Preparation of a Saturated Solution. —A saturated solu¬ 
tion may be prepared by finding the saturation point of 

the substance required, from the tables on the following 

pages, and preparing such a solution in the usual manner. 
The nurse may prepare such a solution, however, by merely 
adding the desired substance to the fluid until it no longer 
dissolves but forms a sediment. The fluid is then a 

saturated solution of the dissolved substance. 

Supersaturation 

When a saturated solution of any substance is heated, it 
is able to dissolve more of the same substance. A solution 
which contains the largest quantity of a substance that it 
can dissolve when the fluid is heated is called a super- 

satuiated solution. 


SOLUTIONS 


Table of Saturation Points of Commonly Used Solutions 
For Local Use 


Name of Solution 

Sat. Point 
in 

Water 

Sat. Point 

in boiling 

Water 

Sat. Point 

in 

Alcohol 

Sat. Point 

in 

Glycerin 

Alum . 

10% 

80% 

insoluble 

freely 





when warm 

Benzoic Acid .... 

0 . 4 % 

6 % 

30% 


Bichloride of 





Mercury . 

7 % 

33 % 

25% 

7 % 

Boric Acid . 

5 % 

25% 

7 % 

20% 

Carbolic Acid .... 

8% 

All pro- 

All pro- 

All pro- 



portions 

portions 

portions 

Cocaine . 

0.2% 

Decom- 

17% 



posed 


Cocaine 





Hydrochloride . 

70% 

Decom- 

40% 




posed 



Gallic Acid . 

1% 

25% 

20% 

8% 

Lead Acetate ... 

30 % 

50% 

3 % 


Potassium 





Bicarbonate ... 

25% 

Decom- 





posed 

insoluble 


Potassium 





Carbonate . 

50 % 

70% 

insoluble 


Potassium Chlorate 

6% 

40% 

slightly 





soluble 


Potassium 





Permanganate . 

6% 

25%, 

Decom- 


Silver Nitrate . . . 

65% 

90% 

posed 

4 % 


Sodium Borate .. 

5 % 

66% 

insoluble 

50 % 

Sodium 





Bicarbonate 1 .. 

8% 

Decom- 





posed 

insoluble 


Sodium Carbonate 

25 % 

35 % 

insoluble 


Sodium Chloride . 

26% 

30% 

insoluble 


Tannic Acid .... 

75 % 

very 

30 % 




soluble 



Zinc Sulphate ... 

65% 

83% 

insoluble 



1 It may be noted that sodium bicarbonate is decomposed 
by boiling, which occurs in solutions of any strength. This 
should be remembered in preparing sterile sodium bicarbonate 
solutions for intravenous use. The solution cannot therefore 
be sterilized after it is prepared. The powder itself may be 
sterilized by dry heat of a low temperature and dissolved in 
sterile water when needed. 


































SOLUTIONS 


Table of Saturation Points of Commonly Used Solutions 
For Internal Administration 


Name of Solution 

Sat. Sol. 

in 

Water 

Sat. Sol. 

in boiling 

Water 

Sat. Sol. 

in 

Alcohol 

Sat. Sol. 

in 

Glycerin 

Ammonium 





Carbonate . 

20% 

Decom- 





posed 



Ammonium 





Chloride . 

33 % 

50% 

2% 

17% 

Ammonium 





Bromide . 

45 % 

53 % 

7% 


Ammonium Iodide 

62% 

70% 

10% 


Calcium Oxide . . 

0.1% 

0.06% 

insoluble 


Hydriodic Acid .. 

10% 

All pro- 

All pro- 




portions 

portions 


Lithium Bromide. 

62% 

70% 

very 





soluble 


Magnesium 





Sulphate . 

54% 

88% 

jti soluble 


Methyl Salicylate. 

slightly 

very 

very 


Potassium Acetate 

71% 

More 

33 % 




soluble 



Potassium 





Bicarbonate ... 

25 % 

Decom- 

insoluble 




posed 



Potassium 





Rit^rtrate . 

0.5% 

5 % 

slio’htlv 


Potassium Bromide 

50% 

50 % 

0 - 5 % 


Potassium Citrate 

66% 

very 

slightly 


Potassium Iodide. 

100% 

100% 

8% 

30% 

Potassium and So- 





dium Tartrate. 

45 % 

50% 

insoluble 


Quinine 





Bisulphate .... 

10% 

Decom- 

5 % 

5 % 

Quinine 





Hydrochloride . 

100% 

Decom- 

62% 

11% 



posed 



Quinine Salicylate 

1% 

Decom- 

8% 

6% 

Quinine Sulphate. 

0.1% 

Decom- 

1% 

3 % 



posed 



Salicylic Acid ... 

0.3% 

6 % 

33 % 


Sodium Acetate . 

50% 

All pro- 

4 % 




portions 



Sodium 





Bicarbonate ... 

8 % 

Decom- 

insoluble 


Sodium Citrate .. 

50% 

posed 

71% 

slightly 


Sodium Bromide . 

50% 

55% 

7 % 


Sodium Iodide .. 

100% 

100% 

25% 


Sodium Salicylate 

55 % 

very 

15% 




soluble 

very 





soluble 


Strontium Bromide 

50 % 

70% 



Sodium Sulphate. 

26% 

Decom- 

insoluble 

soluble 

Sodium Phosphate 

15 % 

Decom- 

insoluble 


1 


posed 










































SOLLT. ONS 


Table of Usual Strengths of Commonly Used Solutions 
For External Use 


Name of Solution 


Alcohol . 

Aluminium Acetate (Bur¬ 
row’s Solution) Stock sol. 
Aluminium Acetate (Bur¬ 
row’s Solution) for local 

use . 

Argyrol . 

Boric Acid .. 

Calcium Hydroxide Solution 

(lime water) . 

Carbolic Acid . 

Collargol . 

Cocaine Hydrochloride .... 

Chlorine Water . 

Corrosive Sublimate (Bi¬ 
chloride of Mercury) Stock 

Alcoholic Solution . 

Corrosive Sublimate . 

(Bichloride of Mercury) 

(for use) .( 

Creolin . 

Cresol . 

Eserine Sulphate . 

Eserine Salicylate . 

Formalin (Stock) Solution .. 

Formalin (for use) . 

Holocain . 

Hydrogen Peroxide . 

Ichthyol . 

Iron Subsulphate (Monsell’s 

Solution) . 

Iron Tersulphate . 

Iodoform . 

Labaracque’s Solution (So¬ 
lution of Chlorinated Soda) 
Lugol’s Iodine Solution ... 

Lysol . 

Naphthol . 

Pilocarpine Hydrochloride .. 

Potassium Chlorate . 

Potassium Permanganate ... 

Protargol . 

Resorcin . 

Sodium Chloride (salt) (Nor¬ 
mal Solution) . 

Sodium Chloride (salt) (Phy¬ 
siological Solution) . 

Silver Nitrate . 

Zinc Chloride . 

Zinc Sulphate . 


Percentage of 
Solution 

Quantity to 
Quart 

50 to 95% 

.^xvi to xxx 

2 to 7% 

3 v to ^ii 

V* to 2% 

3i to v 

5 to 25% 

Mi }4 to viii 

3% 


%% 

3ss 

2 to 5 % 

3v to &V 

4 % 

3 i /4 

V to 4% 

3iV4 

0.4% 


2% 

3 v 

O.OI to 0.1% 

grs. ii to xv 

I-IOOO to 1-10000) 


Vi to 2% 

3il4 to v 

5% 

KVi 

V to 1% 

3 i 54 to iiVi 

V to 1% 

3i l A to UVi 

40% of 


formaldehyde gas 


0.05 to V% 

gr. x to ZiV* 

1 to 2% 

3'iiVi to v 

3% 

^i 

5 • to 50% 

£i Vi to xvi 

13 % 

Siv 

10% 

&ii 

5 to 10% 

%\Vi to iii 

2 Vi % 

3 vi 

5% 

ZiX 

V. 1 to 3% 

3> to ^i 

1 to 50% 

3ii}4 to xvi 

Vi to 2% 

3 i Va to v 

2 to 5% 

3v to f^Vi 

I to 5 % 

3 ii )4 to %i l V 

Vi to 10% 

3i l A to iii 

25 % 

3viii 

0.9% 

3 ii 

0.6% 

3iVi 

I to 20% 

3HV to vi 

I to 2% 

3 ii Vi to v 


grs. xxv 








































SOMNIFACIENTS 


Table of Usual Strengths of Commonly Used Solutions 
For Internal Use 


Name of Solution 

Percentage of 
Solution 

Quantity 
to Ounce 

Ammonium Bromide . 

25% 

3 ii 

Ammonium Iodide . 

50% 

3 iv 

Aromatic Spirits of Ammonia 

4 % 

grs. x 

Arsenous Acid Solution ... 

1% 

grs. v 

Caffeine Sodium Benzoate . . 

25 % 

3 ii 

Camphor Oil . 

20% 

3 i /4 

Camphor Spirits . 

10% 

gr. 1 

Camphor Water . 

0.8% 

gr. \V2 

Dilute Acetic Acid . 

6 % 

m. xxx 

Dilute Hydrochloric Acid . .. 

10% 

m. 1 

Dilute Hydrocyanic Acid ... 

2% 

m. x 

Dilute Nitric Acid . 

10% 

m. i 

Dilute Nitrohydrochloric Acid 

20% 

3 i% 

Dilute Sulphuric Acid .... 
Diuretin Solution (Theobro- 

10% 

m. 1 

mine Sodium Salicylate) . 
Epinephrin Chloride (Adrena- 

25% 

3 u 

lin Chloride) . ; 

Fowler’s Solution of Arsenic 

0.01% (1:1000) 

gr. V2 

(Liquor Potassii Arsenitis) 

1% 

grs. v 

Homatropine Hydrobromide. 

2% 

grs. x 

Mercury Salicylate . 

Morphine Sulphate (Magen- 

0.02% (1:5000) 

gr. Vio 

die’s Solution) . 

3 % 

grs. xv 

Nitroglycerin solution. 

Paregoric (Tinct. Opii. Cam- 

1% 

grs. v 

phorata) .. • • 

Potassium Iodide Solution 

0.4% 

grs. 11 

(Saturated) . 

100% 

I 1 / 

Potassium Iodide Solution .. 

50 % 


Sodium Bromide . 

50 % 

5 iv 

Sodium Iodide Solution .... 

50 % 

VA 

Spirits of Chloroform . 

10% 

m. 1 

Spirits of Ether . 

30% 

3 ii 54 

Spirits of Ether (Compound) 

30% 

3 nA 

Strontium Bromide . 

50 % 

3 iv 


SOMNIFACIENTS 

See Hypnotics. 

SOMNOFORM 

See Anesthetics. 

SOPORIFICS 


See Hypnotics. 




























SPIGELIA 


SPANISH FLY 

See Cantharides. 


SPARTEINE 

Sparteine is a fluid alkaloid which is contained in sco- 
parius or broom tops. 

When given internally, its effects appear in half an hour 
and last for several hours. It is absorbed from the stomach, 
and it then acts like gelsemium or conium. It weakens 
muscular contractions by paralyzing the nerve endings in the 
muscles. It is not as poisonous as either of these drugs, 
but it affects the heart more. 

Action on the heart: Sparteine makes the heart beat 
slower and weaker; by weakening the contractions of the 
heart muscle, thereby causing a slow, weak pulse. 

Sparteine was formerly considered a heart stimulant, but 
its use for this purpose has been given up, as its action 
seems to contraindicate such use. 

Sparteine does not increase the flow of urine as does 
scoparius, the crude drug from which it is obtained. 

Poisonous Effects 

The poisonous effects of sparteine are the same as those 
of conium. 


Preparation 

Sparteine Sulphate; dose Vis to 2 grains. 

See Scoparius, and Conium. 

SPICAS 

See Fractures. 

SPIGELIA (PINKROOT) 

Spigelia or pinkroot is the root of the Spigelia marilan- 
dica, or Carolina pink, a plant growing in the southern 
United States. 

Spigelia is used to remove round worms. As it does not 
destroy the worm, it must be followed by a brisk cathartic. 

Poisonous Effects 

Overdoses of spigelia have occasionally produced the 
following symptoms, especially in children: 

1. Dry, flushed skin. 

2. Puffiness and swelling of the face. 


SPINAL CORD, SURGERY OF 

3. Rapid pulse, delirium and stupor. 

4. Dimness of vision or temporary blindness. 

Preparation 

Fluidextract of Spigelia; dose 1 to 2 drams. 

For a child, 10 minims is given on a piece of sugar, 
often together with senna. 

See Anthelmintics. 


SPINAL CORD, SURGERY OF 

The surgery of the spinal cord is really limited to one 
operation ( laminectomy ). Its object is to expose the spinal 
cord for examination in those cases suffering from cord 
pressure due either to a tumor mass or bone fragments of 
some vertebral fracture. The procedure consists in an 
incision over the desired vertebrae, retracting the muscles 
attached to the vertebral column, exposing the laminae and 
spines of the vertebrae, which are then removed with 
rongeurs, laminectomy forceps, saws, and chisels, exposing 
the dura of the spinal cord. This is then carefully incised 
and an exploration of the cord is made. The dura is then 
sutured and the muscles drawn over it. A moulded cast 
is applied over the back well into the trunx, and the wound 
permitted to heal. 


SPINAL DOUCHE 

See Douches. 


SPIRITS 

Spirits are preparations of volatile substances dissolved in 
alcohol. 


SPLINTS 


See Fractures. 

SPRAINS 

A sprain is an injury to a joint caused by a sudden, violent 
movement—a wrench, a twist or a strain which, if continued, 
■would result in a fracture or dislocation. 

The result is bruising of the synovial membrane, which 
causes very severe and sometimes sickening pain because 
of its abundant nerve supply; a rupture or severe stretching 
of the ligaments, tendons and muscles which support the 


SPRAINS 


joint; and a rupture of blood vessels with bleeding into the 
tissues and often into the synovial sac. 

This injury to the tissues is followed by an inflammatory 
reaction which gives rise to an inflammatory exudate in the 
ligaments, tendons, muscles, subcutaneous tissue, and some¬ 
times into the synovial sac. 

Sprains of the wrist and ankle are the most common 
because these joints are more exposed to injury, but sprains 
of the elbow and knee and other superficial joints also 
occur. 

Symptoms. —There is first very severe pain, sometimes so 
severe as to cause fainting or nausea and vomiting. The 
joint swells quickly, is extremely tender to the touch, and 
soon becomes discolored if the surface blood vessels have 
been injured. Discoloration from rupture of the deeper 
vessels may not appear for a day or two. When the inflam¬ 
matory reaction begins there is heat and increased swelling, 
tenderness and pain on motion. 

Treatment. —A sprain is often very wrongly considered a 
slight injury—“just a sprain”—when in reality it may be 
a very serious injury. A fracture may be very easily and 
is frequently mistaken for a sprain. Even a surgeon is 
sometimes unable to determine the diagnosis without the 
aid of the X-Ray and sometimes a general anesthetic. Even 
a sprain, if neglected or carelessly treated, may result in 
a permanently weak joint or in a partial or complete stiff¬ 
ness with continued pain. It is dangerous to attempt to 
“walk off” a sprain of the ankle unless it is very slight 
or has been properly treated and supported by a surgeon. 

The treatment depends upon the . severity of the case and 
also varies with different surgeons. Efforts are first made 
to relieve the pain, to arrest the hemorrhage and serous 
effusion and to aid its absorption. Sometimes cold applica¬ 
tions in the form of ice-compresses, aluminium acetate, or 
aluminium and opium solution are used with the part 
elevated and kept at rest. Sometimes the part is immersed 
in hot water, the temperature being gradually increased 
until it is as hot as the patient can stand. This relieves 
the pain, contracts the blood vessels and lessens the hemor¬ 
rhage and effusion. The part is then tightly bandaged to 
prevent further congestion. Sometimes the part is strapped 
firmly enough to give support and relieve the strain without 
preventing movement and the patient is encouraged to use 
the part freely. This helps to maintain a free circulation 
and to prevent stiffness. For severe sprains well-padded 
splints or molded plaster-of-Paris casts may be used. For 
a sprained wrist the arm may be supported and elevated by a 
sling. To increase the circulation about and in the joint 


SQUILL 


local applications of heat (baking, electric light, high fre¬ 
quency current, hot water), massage, and passive move¬ 
ments are used. 


SQUILL (SCILLA) 

Squill is obtained from the bulb of the Urguinea maritima, 

the sea onion, a plant growing in the southern part of 
Europe. The outer coat of the bulb is removed, and the 
bulb is then cut into slices. From these slices the prepara¬ 
tions are made. 

Squill acts like digitalis but it is not as reliable. It is 
more rapidly absorbed, however, and after absorption it 
especially increases the secretions of all mucous membranes. 
It is therefore frequently used to loosen and increase the 
cough, especially in old people. In such patients the mild 
improvement of the heart action and the increased secretion 
of the kidneys benefit the general health as well. 

Preparations 

Syrup of Squill; dose 30 to 60 minims. 

Compound Syrup of Squill; dose 10 to 30 minims. 

This contains squill, senega and tartar emetic. 

Guy’s or Fothergill’s Pill 

This contains calomel, squill, digitalis (powdered leaves); 
one grain of each. It is an excellent diuretic. 

Squill is usually given in pill form for diuretic action. As 
an expectorant the syrup is usually given. It is also con¬ 
tained in Stokes’ expectorant. 

STAINS, TO REMOVE 

Removal of Stains from Linen. —Stains may be organic as 
in the animal stains from meat, blood, eggs, milk, fat, 
perspiration; or vegetable and fruit stains from oils, mildew, 
and various fruits and vegetables. They may be inorganic 
as from ink, paint, medicines, mineral acids, or alkalies. 

The agents used to remove them may be: 

(1) Solvents.—Water (cold or boiling): Acids such as 
oxalic acid crystals (1 per cent.): Alkalies such as ammonia. 
Volatile liquids such as alcohol, ether, or chloroform. 

(2) Absorbents such as starch, blotting paper, fuller’s 
earth, or magnesia. 

(3) Chemicals such as soap solution, gasoline or benzine. 

(4) Bleaches such as Javelle water, borax, sunshine, per¬ 
oxide of hydrogen, or dilute ammonia. 

General Rules for the Removal of Stains.— (1) Remove 



STAINS 


stains as soon as possible to prevent fixation in the fiber. 
(2) Try the simplest methods first. (3) Cold or tepid water 
or milk will not fix a stain—hot water will fix some stains, 
while soaking in cold water will often aid in removal. (4) 
Soap sets a stain, therefore always remove a stain before 
the article is washed. (5) When using boiling water, 
stretch the stained part over a bowl and pour absolutely 
boiling water with force (kettle held high) through the 
stain until it disappears. (6) When using an acid, stretch 
the stained part over a bowl of boiling water, apply the 
acid with a medicine dropper or old toothbrush, dipping the 
stain occasionally into the water and again applying the 
acid. When the stain disappears rinse thoroughly in clear 
water, then in tepid water containing a little ammonia which 
will neutralize any acid remaining and prevent any injurious 
effect. (7) When bleaching by the sunlight, wet the cloth 
or stain and lay it upon the grass in the direct sunshine. 
Sunlight bleaches by oxidation in the presence of moisture. 
Keep the stain moist and leave it on the grass as the proc¬ 
ess is slow. (8) Peroxide of hydrogen and dilute ammonia 
also bleach by oxidation and are particularly useful for 
woolens. Use equal parts of fresh peroxide of hydrogen 
and dilute ammonia (one teaspoonful of ammonia to one 
pint of water) and moisten the stain until it disappears. 
(9) When bleaching with Javelle water (which consists of 
1 lb. sal soda, lb. chloride of lime, 2 qts. cold water), 
stretch the article and rub the Javelle water into it; then 
rinse thoroughly and quickly in clear water and finally in 
water containing a little ammonia. (10) Volatile liquids such 
as gasoline, benzene, chloroform err alcohol, etc., should be 
used in daylight, if possible in the open air, and never near 
a lamp or fire, as the fumes are very inflammable. Do not 
put any of these agents on a wet cloth as it weakens the 
action of the liquid and also may leave a stain. (11) 
Always rinse out acids or bleaches thoroughly. (12) Re¬ 
peated short applications of chemicals, washing after each 
in clear water, are less harmful to fabrics than one long 
application. 

Removal of Specific Stains. — Blood! —When fresh or re¬ 
cently dried, soak in cold or tepid water with or without 
ammonia; then rub out; when the stain is brown and nearly 
gone wash out with soap and warm water. If very dry 
apply peroxide of hydrogen; soak and wash out. When 
the stain is old, keep it wet with peroxide of hydrogen and 
ammonia for several hours if necessary. For thick blood 
and blood on bed ticking, apply a thick paste of starch and 
water and allow to stand in the sun; when the paste is 
dry and discolored, remove it and apply a fresh paste. 


STAINS 


Ink. —The method depends upon the character of the ink. 
The following agents and methods may be used: 

(i) When very fresh it may sometimes be washed out in 
clear water. (2) Soak the stained portion in either sweet or 
sour milk for several days if necessary; rinse thoroughly and 
try again if necessary. (3) Apply dilute hydrochloric acid or 
oxalic acid (one-quarter teaspoonful to a cup of water); 

rinse thoroughly. (4) Moisten with salt and lemon juice and 
lay in the sun. (5) Apply salts of lemon (in powder 

form); then pour on boiling water. (6) Apply peroxide of 

hydrogen and dilute ammonia. (7) Apply a few drops of 
hydrochloric acid or oxalic acid; follow by Javelle water, 
then boiling water quickly. (8) Red ink may be removed 
with cold water or water and ammonia or with Javelle 
water. (9) For indelible ink, if the base is silver nitrate, 
apply a 10 per cent, solution of potassium cyanide; if the 
base is an anilin dye, it cannot be removed. 

Chocolate or Cocoa. —Wash in cold water (first covering 
with borax helps); rinse and then pour boiling water 
through it. If unsuccessful use a bleaching agent. 

Coffee. —Pour on boiling water from a height. If un¬ 
successful use a bleaching agent. 

Tea. —Rub out in cold water; then pour on boiling water. 
Glycerin may be used first to soak the stain. 

Fruit. —Apply warm alcohol to soften and dissolve the 
stain; then pour on boiling water from a height; or rub 
with salt before applying the boiling water. If unsuccessful 
use oxalic acid or a bleaching agent. 

Milk or Cream. —Wash out with cold water; then soap 
and tepid water. 

Vaselin, grease, oils cannot be removed if washed in water. 
Soak vaselin stains in kerosene before washing—the kero¬ 
sene evaporates; or wash with turpentine; oil may be 
absorbed by using blotting paper or powdered chalk. Gas¬ 
oline may be used for materials that cannot be washed; 
chloroform or carbona may be used; they are better and 
there is no danger from flame or explosion. Always rub 
toward the center; use by daylight and in a draft and have 
several folds of clean cloth under the stain. 

Medicines may usually be removed with alcohol. 

Iodine. —Apply ammonia or chloroform and wash in warm 
soapy water. 

Argyrol. —Soak in 5 per cent, potassium cyanide. 

Silver Nitrate. —Apply 10 per cent, solution of potassium 
cyanide, apply bichloride of mercury, then wash. 

Picric Acid. —Soak for one minute in a solution of po¬ 
tassium sulphate; then wash with soap and water or apply 
a paste of magnesium carbonate for an hour or so. 


STIGMATA 


Mucus .—Wash in ammonia and water before using soap, 
or in salt and water. 

Perspiration .—Use a strong soap solution and let the 
articles lie in the sun. For perspiration under the arm use 
dilute hydrochloric acid. 

Rust .—Lemon juice, salt and sunlight may dissolve it, or 
dilute hydrochloric acid, oxalic acid and dilute hydrochloric 
acid may be used. 

Acids .—Sponge with water and a few drops of ammonia. 

Balsam of Peru .—Soak in kerosene or alcohol. 

Urine .—Wash with warm water and soap; sponge with 
alcohol. 

Mildew .—If fresh, it may be removed, but when old, it 
cannot be removed. Moisten with a strong soap solution; 
apply a paste of soap or salt and chalk and leave in the 
strong sunlight for several hours; if unsuccessful use Javelle 
water or other bleaching agent. 

STATUS EPILEPTICUS. 

See Epilepsy. 


STEAMING 


See Food, Preparation of. 

STEAROPTENE 


See Oils. 


See Mosquitoes. 


STEGOMYIA 


STEREOTYPY 

Stereotypy is the performance of the same acts in the 
same way over and over, walking in a limited space, striking 
the chest, shaking the body, rubbing or pulling the hair, etc. 

STERILIZATION 

See Disinfection. 

STERULES 

Sterules are glass capsules containing a sterile solution of a 
drug. They are used for hypodermic administration. 

* STIGMATA 


See Mental Deficiency. 


STIMULANTS 


GO 

EH 


H 

CO 


to 

H 

z 

< 

D 

s 

H 

C /3 

>< 

x 

o 

H 

< 

J 

D 

Cj 

o: 

U 

b 

O 

W 

►J 

« 

< 

H 


® ® 

to u 

■gs 

M w 

ii 

t-s 

to a 

tuD,Q 

s* 

05 


®° 

“ (H t 

2 7 

rCj Vj. 

CQ E 
W C 

W) O 


O 

ca 


‘i-. ^.5 

^ Cx 

£h aJ o 
<u -M -M 

.S' 3 S 

o,.ti b 
UDh w 


c S 
'u 3 


<u J 3 

c a 


c — 


te M i 

«a 6.23 

uw<<lg 


Drugs causing a 
slow pulse 

Digitalis 

Strychnine 
Epinephrin 
Pituitary Extract 
Camphor 
(sometimes) 
Strophantus 

Squill 

C®nvallaria 

Apocynum 

Adonis Vernalis 

Drugs causing a 
rapid pulse 

Caffeine 

Atropine 

Ammonium 

Alcohol 

Camphor 

(sometimes) 

Musk 

Drugs acting 
slowly. Suitable 
for continuous ef¬ 
fect 

Digitalis 

Strophantus 

Squill 

Convallaria 

Apocynum 

Adonis Vernalis 

Drugs acting 
rapidly. Suitable 
for immediate ef¬ 
fect 

Caffeine 

Strychnine 

Atropine 

Camphor 
Epinephrin 
Pituitary Extract 
Ammonium 

Alcohol 

Digalen 

Digipuratum 

(ampoules) 

Muck 













STOMACH, NURSING IN DISEASES OF 

STINGS 

See Bites and Stings. 

STOMACH, NURSING IN DISEASES OF 

In nursing diseases of the stomach the most important 
feature of the nurse’s work is to consider the main function 
of the stomach, namely—digestion; and ascertain by the 
observation of symptoms the degree of incapacity that exists 
in the performance of this function; and to know if the 
loss of function is of organic or mechanical nature. Dieto- 
therapy is the treatment of disease by prescribed foods and 
is most frequently used in treating stomach diseases. 

In Children 

In infancy we rarely find the stomach involved alone, 
being associated with the intestines in nearly all diseases. 
At birth, the capacity of the stomach is approximately i]/2 
ounces and the rate of growth about i ounce for each month. 
The position is almost vertical so that regurgitation is ac¬ 
complished with ease. To overcome a tendency to regurgi¬ 
tate, babies should have the head elevated after feeding. 

Vomiting is a condition arising from a great number of 
sources, and is of various types, viz.: habit vomiting, pro¬ 
jectile vomiting, stercoraceous vomiting, etc. 

Hematemesis is the term applied to vomiting of blood. 
It is important to note the type and duration of vomiting 
and the character of vomitus. 

The most common malformation of the stomach is stenosis 
of pyloric or cardiac orifice.— Pylorospasm is a spasmodic 
affection of pylorus and tends to develop an overgrowth 
of circular muscle fibers at this point with a resultant ob¬ 
struction. Dietotherapy is the usual treatment. Feedings 
are at four hour intervals of five to eight minutes duration. 
Sometimes a definite quantity of food is prescribed in which 
case breast-fed babies are not permitted to nurse but the 
desired quantity of milk is pumped out and fed to the baby. 

Lavage empties the stomach of food and allays the spasm. 

Acute gastric indigestion is a term applied to a series of 
symptoms caused by the inability of stomach to digest food. 
There is usually vomiting, dulness or excitement, sometimes 
convulsions, rise of temperature ioo°-io2° F. and diarrhea. 
The stools contain undigested food. The nurse should note 
the symptoms carefully and apply heat over the epigastrium 
to control the pain. When feedings are prescribed they 
must be given absolutely according to instructions. 

In Adults 

Acute Gastritis:—This is usually due to indiscretions in 
eating and drinking and is one of the most prevalent com- 


STOMACH, NURSING IN DISEASES OF 

plaints we have to deal with. The symptoms are headache, 
lassitude, feeling of fulness in the epigastrium, some¬ 
times nausea and vomiting with frequent eructations 
of gas. 

The best remedy is to relieve the stomach of the mass 
of food which is probably partially decomposed and fer¬ 
menting; this can be accomplished by the use of mild 
emetics such as a large quantity of luke-warm water with a 
pinch of salt or baking soda—3 to 4 cupfuls. After empty¬ 
ing the stomach a dose of castor oil is usually given to 
remove any undigested food which may have passed on into 
the intestines. 

Chronic Gastritis and Nervous Dyspepsia are so similar 
in symptoms that it is sometimes difficult to differentiate 
the disorders. The treatment is dietotherapy, as the causes 
are in most cases errors .in diet. The ingestion of large 
amounts of fats or carbohydrates, fried foods, excessive use 
of tea or coffee with meals, and too great haste without giv¬ 
ing much thought to proper chewing and mastication are 
the main causes. The treatment is to remove the cause— 
small amounts of food of easily digestible type, sometimes 
a milk diet for a week or two may bring much comfort to 
the patient. In these cases usually, a test meal is given 
and a fluoroscopic examination is made to determine the 
position and motor activity of the stomach. After these 
procedures, a proper diet is prescribed and the nurse’s 
duties are usually very arduous in keeping the hungry 
patient from deviating from this diet. 

In these cases hydrochloric acid (dilute) may be given 

as it is usually lacking, and the normal ferments—pepsin 
and rennin—require an acid medium for their action. 

Dilatation of the Stomach: Dilatation may be acute 
(due to some acute fever, such as typhoid or pneumonia), 
or chronic (due to some obstruction at the pylorus, com¬ 
bined with a weak muscle wall). 

The usual treatment of these disorders is a small amount 
of easily digestible food at three to four hour intervals. 
Lavage between meals helps to restore tone and usually 
makes the patient comfortable. 

Gastroptosis is a condition of weakened muscular tone 

of the walls and ligaments which hold the stomach in posi¬ 
tion permitting the stomach to descend below the normal 
level in the abdomen. Lying on the back with the hips 

and legs elevated for three to four hours daily, together 
with a firm abdominal binder helps to overcome this con¬ 

dition. 

Ulcer of the Stomach: By ulcer of the stomach we mean 
a necrosis of a circumscribed area in the mucus membrane 


STOMACH, NURSING IN DISEASES OF 

which may penetrate through the muscle and peritoneum in 
which case it is termed a perforated ulcer of stomach. 
Superficial ulcers are quite common; they may heal over 
rapidly and do no harm. 

Ulcers may occur singly or in numbers and appear most 
frequently near the pylorus. The patient may have gastric 
ulcer and be entirely unaware of it; but, usually, the symp¬ 
toms of chronic gastritis are present. The grave conditions 
accompanying ulcer are perforation and hemorrhage. 

Hematemesis in adults is very nearly always symptomatic 
of ulcer. Put the patient to bed in a quiet room, place an 
ice-bag over the epigastrium, give absolutely nothing by 
mouth, and call a surgeon. Early treatment or operation 
may save the patient’s life. Delays are extremely dan¬ 
gerous. The after-care of a gastro-enterostomy is a part 
of the training in surgical nursing and requires rigid ad¬ 
herence to the surgeon’s orders. Absolute quiet both for 
mind and body, with the performance of such care as 
the surgeon prescribes usually brings about a good re¬ 
covery. 

Cancer of Stomach: The symptoms of cancer of the 
stomach are loss of weight and strength with a progressive 
anemia, combined with marked symptoms of dyspepsia. The 
vomitus usually contains evidence of slight hemorrhage. If 
the patient does not vomit, traces of blood may be found in 
the stools. The treatment is surgical in the early stages; 
and in the advanced stages usually the administration of 
drugs to keep the patient comfortable. 

Neurosis of the Stomach: The real source of many gastric 
disturbances is not in the stomach itself but in the nervous 
system. The nervous control of the stomach being much 
disturbed, the stomach symptoms are only a part of the 
picture of neurasthenia presented. In these cases, the gen¬ 
eral treatment is rest, psychotherapy and forced feeding; 
because usually the patient objects to so many types of 
food that if left to his own choice, he will usually select 
an unsuitable diet. 

Hyperacidity and subacidity are terms used to indicate 
the amount of acidity above or below normal of the gastric 
juice secreted; and the condition is usually treated after 
correction of diet by the administration of alkalies or acids 
as the case indicates. 

In nursing diseases of the stomach it is very important 
that the nurse should have a knowledge of food values and 
the proper preparation of foods to successfully care for 
these cases. 

Very few medicines are given, but lavage and dieto- 
therapy are constantly employed. 


STOMACH, SURGICAL CONDITIONS OF 


STOMACH, SURGICAL CONDITIONS OF 
Gastric Dilatation (Post-operative) 

One of the most distressing complications which may arise 
after an operation, and one which, if not treated radically, 
energetically, and thoroughly may result in death, is acute 
gastric dilatation. As the name implies, in this condition 
the stomach becomes enormously dilated, and presses upward 
on the diaphragm. This makes respiration very difficult be¬ 
cause of the constant pressure on the diaphragm. And, 
inasmuch as the pyloric orifice of the stomach is atonic, the 
intestinal contents seep back into the stomach, resulting in 
persistent vomiting of large amounts of greenish and brown¬ 
ish colored fluids. To relieve' this condition those means 
must be employed which will cause the dilated stomach to 
contract and approach its normal size. 

Treatment. —The stomach should be lavaged with a hot 
soda bicarbonate solution at no to 112 degrees Fahrenheit, 
and the lavage continued until the return is absolutely clear, 
While this treatment is under way, turpentine stupes should 
be applied to the upper abdomen for ten or fifteen minutes. 
It is important to bear in mind that as these stupes must 
be hot to be efficacious, the abdomen should be thoroughly 
greased with vaseline before applying them, as great care 
must be taken that the skin is not burned. The integrity of 
the skin must be preserved because this precedure is to be 
repeated every two or three hours, according to the discre¬ 
tion of the attending surgeon. The stupe probably is the 
most efficient and reliable method for applying external 
heat, although some authorities advise the use of huge flax¬ 
seed poultices. Strychnine sulphate, gr. 1/60, may be given 
by hypodermic injection every four hours, following the 
principle that the strychnine will improve muscle tone. 

The patient, of course, during this period, should be 
given nothing by mouth, but measures should be taken to 
supply the system with water; this may be administered by 
means of a Murphy drip, or eight ounces of tap water be 
given by rectum every four hours. If the patients show signs 
of shock, which they often do, a hypodermoclysis of 500 to 
800 c.c. of saline should be given, or, in some instances, an 
infusion of saline. If nourishment be an essential element, 
a solution (two to five per cent.) of glucose may be admin¬ 
istered intravenously. 

After the initial period of vomiting has come to an end, 
it is advisable to give the stomach an absolute rest for 
about twenty-four hours, and then to start the patient 
on what may be called a “gastric tolerance diet.” The 
theory of this diet is to partially desensitize the mucosa of 


STOMACH, SURGICAL CONDITIONS OF 


the stomach and make it more tolerant to fluids by the use 
of small doses of chloroform water. If this is retained, 
peptonized milk is then gradually increased, the chloroform 
water is omitted, and the patient, after a period of absolute 
gastric tolerance, is gradually brought over to a selected 
soft diet. 

Gastrostomy 

When the esophagus is narrowed either by a benign 
structure, or carcinomatous tissue to such an extent that 
feeding is practically impossible, a gastrostomy must be 
performed to prevent the patient from starving. This is an 
operation whereby a communication is established between the 
anterior surface of the stomach and the anterior abdominal 
wall. Through this gastric fistula, fluid may be introduced, 
the patient, in this fashion, being given nourishment without 
the food actually entering the esophagus. There are dif¬ 
ferent types of operations done but they all are essentially 
the same: they vary in their technique. 

Ante-operative Treatment. —The abdomen is prepared in 
the usual manner. Inasmuch as these patients are very 
emaciated and weak, the operation is performed under local 
anesthesia, preliminary to which morphine gr. % with 
atropine gr. 1/150 is given hyperdermatically. 

After Treatment. —The patient is fed every four hours 
through the catheter. A convenient way of doing this is to 
connect it with a small funnel so that the fluids may be 
easily poured into the stomach. The foods which may be 
given are limited to those which can be made up into or 
dissolved in fluids, and from six to ten ounces of liquids 
may be given at a feeding. Their caloric value should always 
be estimated and great care should be taken tc see that 

the patient is given sufficient food. Some surgeons permit 
their patients to chew solid food for the taste and because a 
flow of gastric juice is stimulated by the hormone “secretin” 
of the saliva; but, naturally the patients are not permitted 
to swallow the food. 

After the first few days the catheter should be removed and 
changed daily, a fresh clean one always being ready for im¬ 
mediate insertion. After the feeding the end of the tube 

should be clamped so as to prevent leakage, and an ab¬ 
dominal binder applied. In about two months’ time the 

tube may be left out of the stomach, and inserted at the 
feeding periods only. The fistula in the interim may be 
covered with a piece of vaselinated gauze, held in place by 
a binder. Patients should be taught to insert their own 
tubes, the method of feeding themselves, and the foods 
which may be taken. 

It is highly important that the skin about a gastric fistula 


STOMACH, SURGICAL CONDITIONS OF 

be kept scrupulously clean. Should gastric contents leak 
either from or around the tube, the skin should be washed 
immediately and covered with some bland non-irritating oint¬ 
ment, such as Beck’s paste or vaseline. If this is not done, 
the gastric juice will digest the skin and a painful ulcerated 
area about the tube may result. 

Gastro-Enterostomy 

Ante-operative Treatment. —In chronic cases of ulcer of 
the stomach prior to the time of operation, fluid should be 
forced upon the patient so that there will be a reserve 
amount in the tissues. An hour before operation the 
stomach is washed. Great care should be taken that the 
return flow is absolutely clear at the completion of the treat¬ 
ment and that none of the lavaging fluid is left within the 
viscus. 

After Treatment. —There is some degree of shock following 
this type of operation, and it is necessary to administer 
saline hypodermatically, or by rectum by Murphy drip. The 
drip should be kept on for about four hours and off for 
two. This will prevent irritability of the rectal mucosa, 
and insure the proper absorption of the fluid. But as soon 
as the patient is receiving sufficient nourishment by mouth 
the drip may be discontinued. 

When the patient has recovered from the anesthesia, he 
should be placed in Fowler’s position for this position favors 
the passage of the ingested food through the new opening, 
the gastro-enterostomy stoma. Some surgeons are in the 
habit of allowing fluids within a few hours after the anes¬ 
thetic nausea and vomiting have disappeared. Water is 
given in dram doses every hour, and if it is tolerated, after 
a few feedings an ounce of peptonized milk is allowed every 
two hours, alternating with water every two hours. This 
may be followed on about the second or third day by an 
ordinary Lenhartz diet. 

Complications after Gastro-enterostomy. — Hemorrhage. 
Occasionally, after the operation, the pulse may mount in fre¬ 
quency and the patient exhibit all the clinical symptoms of 
hemorrhage. This is evidence of gastric bleeding. The pa¬ 
tient should immediately be placed in an upright position in 
bed, and cold applied over the upper epigastrium by ice 
bags, ice coils or cold compresses. Cold may be applied in¬ 
ternally by permitting the patient to swallow small pieces of 
cracked ice, adrenalin hydrochloride, 1:1000 may be given 
in saline solution by mouth to control the bleeding for its 
local action as a vasoconstrictor is well known, and, at 
times, it is a very efficient hemostatic. 

Vomiting .—In spite of the fact that an operation has been 


STOMACH, SURGICAL CONDITIONS OF 

performed upon the stomach itself, the surgeon will order a 
gastric lavage eighteen to twenty-four hours after operation 
if the vomiting is persistent; this may be repeated as often 
as is necessary. 

Gastric Ulcer 

Gastric ulcer starts as an erosion of the mucosa of the 
stomach, the ulceration gradually extending deeper, at times, 
eating its way through the muscular and serous coats of 
the stomach causing a communication between the interior 
of the stomach and the general peritoneal cavity. The 
ulcer in itself is not so serious but by growing it may open 
a blood vessel, causing a gastric hemorrhage (hematemesis). 
Or the scar tissue which follows in the path of a healing 
ulcer may interfere with the gastric functions by creating 
various deformities of the stomach. This is especially true 
when the ulcer occurs in the region of the pylorus; subse¬ 
quent healing of an ulcer in this location may result in a 
narrowing or stenosis of the pyloric orifice. The third dan¬ 
ger already mentioned is that of perforation, through which 
the gastric contents are emptied into the general peritoneal 
cavity resulting in a peritonitis. 

The symptoms of gastric ulcer, in brief, are epigastric 
pain, vomiting, and bleeding. Although the latter is one of 
the most persistent signs of gastric ulcer it may be absent. 
Examination of the stomach contents may show an increase 
in the amount of free hydrochloric acid and the presence of 
blood. X-ray examination with a bismuth meal may reveal 
an irregularity in the outline of the stomach, indicative of 
ulcer. 

Treatment of Gastric Ulcer. —The treatment is both medi¬ 
cal and surgical. The latter only will be discussed here. 
Surgical treatment is employed when (i) medical treatment 
has given little relief, (2) when perforation of the ulcer 
has occurred, (3) when perforation has resulted in the 
formation of an abscess, or (4) when the pylorus has become 
stenosed. 

The treatment of the chronic cases is to short circuit the 
food contents from the stomach to the jejunum directly, 
instead of first passing through the pylorus and duodenum. 
This will permit the ulcer to heal by giving the pyloric 
portion of the stomach a functional rest; and, in those cases 
of pyloric constriction, the food will now have a free exit 
through the new opening. The establishment of a new 
opening in the stomach and attachment to it of the intestine 
is known as gastro-enterostomy. The jejunum may be at¬ 
tached to either the anterior or posterior surface of the 
stomach resulting in either an anterior or posterior gastro¬ 
jejunostomy. 


STOMACH TUBE 


Perforated Gastric Ulcer 

Ante-Operative Treatment. —Patients suffering from a 
perforation of a gastric ulcer have, as a rule, a beginning 
peritonitis, and as they are more or less in a condition of 
shock, it is advisable that before operation of a grain 
of morphine be given hypodermically. This will relieve to 
a degree some of the intense cramp-like pains and will make 
the inductive stage of anesthesia smoother so that the 
struggling is less. If they are in a state of severe shock, a 
preliminary infusion of about 550 c.c. of saline should be 
given. 

Post-operative Treatment. —As soon as possible the patient 
is placed in the Fowler position, and if greatly shocked a 
clysis is given, of 500 to 750 c.c. of saline. Some prefer 
the administration of saline by rectum, given by Murphy 

drip, four hours on and two hours off. Feeding is begun 
after eight to twenty-four hours, and the patient may be 
placed upon a Lenhartz diet. As a matter of fact, treatment 
for this condition is almost the same as that for a gastro¬ 
enterostomy. 

Cancer of Stomach 

The symptoms of which the patient will complain are 

determined by the area in which the growth is located. If 
it is near the cardiac end where it does not interfere with 
the functions of the stomach there may be no symptoms at 
all. If it is in the fundus of the stomach there may be 
pain, vomiting, loss of weight and anemia. If it is in the 
pyloric portion, these symptoms are duplicated and there is 
a greater tendency to vomit because of the obstruction. 
Examination of the stomach contents in these cases may 
reveal a low acid content, no free hydrochloric acid 

and often the presence of lactic acid. X-ray examination 
is sometimes a valuable aid to diagnosis, and occasionally, 
the tumor mass may be felt in the upper abdomen in the 
position of the stomach. 

Surgical Treatment of Cancer of Stomach. —The only hope 
in cases of gastric cancer is partial or complete excision of 
the stomach (gastrectomy). The operation is rather shocking 
and the mortality is high. The technique for operation and 
the post-operative care are practically the same as that 

already described in the treatment of gastric ulcer. 


STOMACH TUBE 


See Lavage. 

STOVAINE 

Stovaine is an artificial alkaloid which is used principally 
as a local anesthetic and for spinal anesthesia. Its effects 
are similar to those of cocaine with the following differences: 


STROPHANTHUS 


1. It dilates the blood vessels. 

2. It is less poisonous than cocaine. 

In the eye it is used in a 4 per cent, solution. On other 
mucous membranes, in a 5 to 10 per cent, solution. Hypo¬ 
dermically, it is used in a ^ to 1 per cent, solution. 

Preparation 

Stovaine (in tablets) each containing of a grain. 

See Cocaine. 

STRAMONIUM (THORNAPPLE, JAMESTOWN WEED) 

Stramonium is obtained from the leaves of the Datura 
stramonium, a weed growing in England and the United 
States. Its active principles consist mostly of hyoscine but 
it also contains atropine and hyoscyamine. 

Appearance of the Patient 

Stramonium is usually given to patients suffering from an 
attack of spasmodic asthma. 

When a preparation of stramonium is given, or the fumes 
of burnt stramonium leaves inhaled, the patient is relieved 
of the asthmatic attack. The breathing is easier, the pulse 
is strong and rapid. The patient complains of dryness of 
the mouth and throat and is very thirsty. The pupils are 
dilated, and the patient is somewhat more active and more 
talkative. 

Administration 

Stramonium is given in the form of cigarettes, which are 
smoked during an attack of asthma, or the leaves are burned 
in a saucer and the smoke inhaled. It relieves the attack 
by relaxing the spasm of the involuntary muscles of the 
bronchi. 

Preparations 

Stramonium leaves made up into cigarettes, or the plain 
dried leaves are the most commonly used preparations. 

Extract of Stramonium; dose V\ to Yi of a grain. 

Fluidextract of Stramonium; dose 1 to 2 minims. 

Tincture of Stramonium; dose 5 to 15 minims. 

Stramonium Ointment. 

This contains 10 per cent, of the extract of stramonium. 
It is used principally for painful hemorrhoids. 

STRAPPING 

See Fractures. 

STROPHANTHUS 

Strophantlius is a drug obtained from the ripe seeds of 
the Strophanthus hispidus, a climbing shrub of Africa. Its 
active principle is a glucoside, strophanthin. 


STROPHANTHUS 


Action 

Strophanthus acts like digitalis but its effects vary in the 
following instances: 

1. When given by mouth it may not be absorbed; therefore 
its effects are unreliable. 

2. It increases the contraction of heart muscle more than 
digitalis does. 

3. It Is much more poisonous than digitalis; the poisonous 
effects appear more suddenly and are more severe. 

4. It frequently causes profuse diarrhea. 

5. It is more rapidly eliminated than digitalis. 

Its active principles, however, are very useful for in¬ 
travenous use. 

Preparation 

Tincture of Strophanthus, dose 5 to 15 minims. 

See Digitalis. 

STRYCHNINE 

See Nux Vomica. 

STUPES 

See Fomentations. 

STUPOR 

Stupor is a profound disorder of consciousness in which 
ordinary impressions are not comprehended and voluntary 
activity is suspended. The impression may be received 
normally but because some inhibitory process interferes 
with the usual mechanism no reaction takes place. The 
patient is aroused from this condition only by the strongest 
stimuli. The pulse is slow and small, the temperature is 
subnormal, the skin is dry, the extremities cold, the mouth 
is filled and overflowing with saliva, the eyes may be open 
but the mind does not perceive, and no voluntary move¬ 
ments are made. 

ST. VITUS’ DANCE 

This trouble is confined almost altogether to children with 
a highly nervous temperament, and to overcome it a great 
deal of patience and careful watching are required. Plenty 
of sleep is an absolute necessity, and when the nerves are 
too excited to allow of natural sleep, hypnotics must be re¬ 
sorted to. A quiet, easy life should be followed, with simple 
amusements and plenty of outdoor exercise, light but bounti¬ 
ful diet, without meats or stimulating foods, and a free action 
of the bowels daily. A shower bath or brisk sponge bath 
every morning, commencing with lukewarm water, and grad¬ 
ually making it colder, and gymnastic exercises to strengthen 
the muscles, are very beneficial. 


SUBNORMAL TEMPERATURES 


STYPTICINE (COTARNINE HYDROCHLORIDE) 

Cotarnine hydrochloride, or stypticine, is an artificial 
alkaloid, made by oxidizing narcotine, an alkaloid of opium. 

It contracts the blood vessels and the uterus. 

It is principally used to check bleeding from the uterus. 
It is also used to check bleeding from other parts of the 
body, such as the lungs, the stomach, or the intestines, by 
contracting the blood vessels of these organs. Gauze soaked 
in cotarnine is frequently used by dentists to check bleeding. 

Preparations 

Cotarnine Hydrochloride (Stypticine) ; dose x /\ to 2 grains. 

It is given hypodermically in solution, or by the mouth in 
pills or tablets. 

Cotarnine Phthalate (Styptol). 

Hypodermically 3 grains dissolved in 30 minims of water. 

By mouth, 3 to 5 tablets a day. Each tablet contains 
M of a grain of the drug. 

STYPTICS 

See Hemorrhage. 

SUBINVOLUTION OF UTERUS 

This is a condition of delayed or arrested involution. It 
is always due to some local condition such as retention of 
fragments of placenta or membranes, pelvic inflammation, or 
displacements of the uterus. Frequently it is associated 
with over-exertion during the puerperium. The symptoms 
are a prolongation of the lochial discharge, or a reappearance 
of blood in it, along with some dragging pain and weakness. 
Gn examination the uterus is found to be larger than it 
should be at the particular period of involution, and soft 
and boggy. Hot douching and the administration of ergot 
thrice daily may effect a cure. In marked cases, and where 
there is anything retained, the uterus should be curetted. 

SUBNORMAL TEMPERATURES 

Temperatures Below Normal. —The body must maintain 
a certain degree of heat in order to carry on the chemical 
changes in the tissues upon which the maintenance of life 
depends. Life can be maintained for a short time only at 
a temperature of 95 0 F. or below. Subnormal temperatures 
may be due to: (1) excessive heat elimination, as from 
profuse sweating, night sweats, a severe hemorrhage, or loss 
of other body fluids; (2) lessened heat production, as in 
starvation and lowered vitality. In starvation the patient 
lives on his own tissues, the muscles and other tissues being 
used to supply the heat and energy necessary to carry on 


SUGAR, TESTS FOR 

the vital functions of the heart and respirations, etc. These 
are spared until the last. (3) Extreme depression of the 
nervous system as in shock or collapse. All the nerve 
centers which control and stimulate the functions of the body 
are depressed and inactive so that the functions of .every 
organ, including the heart and lungs, will be weakened 
and may be entirely suspended. 

See Shock. 


SUGAR, TESTS FOR 

See Diabetes Mellitus. 

SUGAR OF MILK 

Sugar of Milk (Saccharum Lactis) is used as a flavoring 
substance and to give consistency to powders. 

SUGGESTIBILITY 

Suggestibility is a condition in which the activity is deter¬ 
mined by impressions or suggestions received from others. 
There are three types: Echolalia, the tendency to repeat 
the exact words of another; echopraxia, the tendency to 
repeat or imitate the movements of another; and catalepsy, 
the tendency to hold or maintain by muscular rigidity a 
given position. If the arms are extended over the head, 
they will be held in that postion for a very long time, it 
may be all day, unless some one changes them. Some 
patients who show this tendency can be molded or fashioned 
into almost any attitude and the positions are maintained 
indefinitely (Cerea flexibilitas). There is believed to be a 
form of muscular Anesthesia present and the position of 
the various parts of the body is apparently unknown and 
unfelt. 


SULPHONAL 

Sulphonal is a white powder without any odor or taste. 
It does not dissolve readily in water. Within 1 to 6 hours 
after giving a dose of sulphonal, the patient falls asleep. 
The sleep is not very deep, but it lasts for about 8 to 10 
hours, and sometimes longer. The pulse and breathing are 
usually not affected. On awakening, the patient often feels 
drowsy, complains of fullness in the head, and headache; 
and his gait may be a little unsteady. Occasionally, sul- 
Vhonal is so slowly absorbed that it produces sleep the day 
following the night of its administration. 

Action 

Sulphonal resembles chloral in its effects, which appear 
tnore slowly, however. It produces no local effects. 

After absorption, it lessens the activity of the brain, pro- 


SULPHUR 


ducing sleep; and in large doses, sulphonal often makes the 
breathing slow and shallow. It does not affect the heart 
action. 

Idiosyncrasies.—In some individuals, instead of sleep, the 
following symptoms are produced: 

1. Nausea and vomiting. 

2. Excitement. 

3. Dizziness. 

4. Staggering. 

Poisonous Effects 

Acute Sulphonal Poisoning.—An overdose of sulphonal is 
rarely, if ever, fatal. It occasionally causes: Stupor, and 
slow, shallow breathing. 

Cumulative Sulphonal Poisoning.—Since sulphonal is more 
slowly excreted than it is absorbed, its prolonged use often 
causes the following alarming symptoms, which may even 
result in death: 

1. Pink color of the urine. 

2. Abdominal pain. 

3. Nausea and vomiting. 

4. Constipation. 

5. Weakness and unsteady gait. 

6. Mental confusion and hallucinations. 

7. Paralysis of various groups of muscles of the arms or 
legs. 

8. Suppressed urine; the urine often containing albumin. 

9. Collapse, which may result in death. 

Treatment.—1. Stop the drug. 

2. Saline diuretics are usually given., 

3. Move the bowels thoroughly. 

4. The collapse is usually treated with heart stimulants. 

Administration 

Sulphonal is best given in large quantities of milk or hot 
water several hours before bedtime. Dose 15 to 30 grains. 

SULPHUR 

Sulphur is an element which occurs in the form of a yellow 
powder. It is found in volcanoes and also as compounds 
of various metals. 

Local action: Applied to the skin it slightly checks the 
growth of bacteria and destroys parasites (parasiticide). 
It stains silver objects black, by forming silver sulphide. 

Internal Action: When taken internally, the sulphides 
which it forms in the intestines increase the secretions; 
producing mild movements of the bowels. It is eliminated 
from the body as sulphides by the expired air; to which it 
gives a very foul odor, and also by the stools. 


SULPHUR DIOXIDE 


Poisonous Effects: Continued use of sulphur often causes 
anemia, great wasting and tremors of the muscles. 

Preparations 

Washed Sulphur; dose 15 to 60 grains. 

Precipitated Sulphur; dose x to 4 drams. 

Sublimed Sulphur, or Flowers of Sulphur; dose 1 to 4 
drams. 

Sulphur is best given in a small quantity of syrup. 

Sulphur Ointment. 

This contains 15 per cent, of sublimed sulphur with ben¬ 
zoin and lard. 

Liver of Sulphur (Potassa Sulphurata). 

This is a preparation of sulphur which is often used in 
ointments and baths in doses of 1 to 6 drams of sulphur 
to a gallon of water. This substance is very destructive to 
tissues (corrosive). 

SULPHUR DIOXIDE 

Sulphur dioxide or sulphurous acid is a gas which is 
formed when sulphur is burned. It is an excellent disinfect¬ 
ant for rooms; but it is apt to injure clothing, linens, 
carpets, etc. 

Uses: Sulphur dioxide is formed when sulphur candles 

or sulphur masses are burnt in the room. The sulphur 
should be placed in a metal or porcelain dish placed in a 
basin of water, and the sulphur should then be burned. All 
cracks and key-holes in the room should be tightly closed. 

SULPHURIC ACID (OIL OF VITRIOL) 

Sulphuric acid acts like the other acids, except that it 
checks intestinal secretions and the sweat. 

It is rarely used except as a remedy for lead poisoning 
and occasionally to check diarrhea and night sweats. The 
concentrated acid is occasionally used to destroy an infected 
area of the skin (caustic action). 

Preparations 

Dilute Sulphuric Acid; dose 10 to 30 minims. 

This contains 10 per cent, of sulphuric acid. 

Aromatic Sulphuric Acid; dose 5 to 15 minims. 

This contains 20 per cent, of sulphuric acid in alcohol, 
flavored with ginger and cinnamon. 

For Local Use: Sulphuric Acid (Oil of Vitriol. 

This contains 9 2 per cent, of sulphuric acid. 

See Acids, Inorganic. 


SUMACH 

See Rhus Glabra. 


SUPPOSITORIES 


SUMBUL 

Sumbul or vegetable musk is obtained from the root and 
underground stems of the Ferula sumbul, a plant which is 
very little known. Its active principle is a volatile oil. 

It is used principally to allay nervousness and make the 
patient calm and quiet. It may be given in large doses. 

Preparations 

Extract of Sumbul; dose 4 grains. 

Fluidextract of Sumbul; dose 30 minims. 

SUNSTROKE 

Sunstroke or insolation results from exposure, especially 
of the head and neck, to the direct rays of the sun. 

The sun’s rays have a powerful effect on the body, elevat¬ 
ing the body temperature and acting as a powerful excitant 
to the brain and all nerve centers. Marked congestion and 
swelling of the face, scalp, meninges, and brain occur. 

The symptoms are violent headache, mental excitement 
which may become maniacal, convulsions, and loss of con¬ 
sciousness. The attack may prove fatal or, if the patient 
recovers there may be permanent impairment of the mind 
with loss of memory or power to concentrate, together with 
other nervous disturbances, and inability to stand exposure 
to heat. 

The treatment is that of heatstroke. 

See Heatstroke. 


SUPPOSITORIES 

Suppositories are cone-shaped preparations of a drug 
made up with cocoa-butter. 

Rectal suppositories may consist of concentrated food, 

soap, glycerin or plain or medicated cocoa-butter. They are 
prepared in the shape of a cone. They retain this shape at 
a normal or room temperature but when introduced into the 
rectum are dissolved by the heat of the body. Drugs con¬ 
tained in them are then set free. 

Varieties of Suppositories Used .—1. Evacuant. —Soap and 
glycerin suppositories are used to cause the expulsion of 
feces. They are particularly valuable when the feces are in 
the lower bowel or rectum, but cannot be expelled because 
the tight or sensitive anal sphincter will not relax. The irri¬ 
tation caused by the presence of the suppository stimulates 
the rectum to expel it. Glycerin suppositories for adult use 
are larger than those used for infants and young children. 
Long, thin suppositories are used for infants. Soap sup¬ 
positories may be purchased ready for use, but may easily 
be made by taking a splinter of white soap and holding 


SUPPOSITOB.IES 


it in hot water until smooth and rounded to the required 
length and shape. It should be cone-shaped and may be 
from one to three inches long. 

2. Astringent suppositories consisting of tannic acid, bella¬ 
donna, and glycerin are used in dysentery and diarrhea to 
contract the tissues, check bleeding, relieve pain and dry 
up the secretions. Bismuth suppositories are used in the 
same conditions. The bismuth forms a coating on the 
mucous lining and prevents irritation. In this way it checks 
diarrhea caused by the irritating contents in the intestines. 

3. Ice suppositories are sometimes used to check local 
bleeding or to relieve local inflammation. An ice sup¬ 
pository may be made in the same way as the soap sup¬ 
pository. It must be of a suitable shape and size, round 
and smooth and free from all sharp edges. 

4. Anodyne or local sedative suppositories are used for 
hemorrhoids, dysentery, diarrhea, rectal abscesses or in post¬ 
operative conditions in which it is necessary to limit peristalsis 
and keep the rectum at rest. The drugs commonly used are 
cocaine, opium and belladonna added to cocoa-butter. Co¬ 
caine relieves pain and by contracting the blood vessels 
relieves bleeding if present. Opium and belladonna relieve 
pain, check peristalsis and dry up secretions. 

5. Suppositories containing opium or veronal acetate are 
given for a general sedative effect when for any reason it is 
inadvisable to give the medication by mouth. 

6. Specific Suppositories. —In malaria large doses of 
quinine given as a specific frequently cause severe gastric 
disturbances on account of the irritating effect of the qui¬ 
nine on the lining of the stomach. To prevent this 
quinine may be given in the form of a suppository. 

Method of Procedure. —A suppository should be well lubri¬ 
cated with a small amount of petrolatum or other lubricant 
before insertion. It should be carried to the bedside in a 
gauze wipe or a small piece of gauze. When inserting the 
suppository a nurse wears a glove and inserts the sup¬ 
pository as far as the finger will reach. Pressure is then 
applied over the rectum for a short time until all desire to 
expel the suppository has passed. A patient should never 
be permitted to insert a suppository. 

Suppositories should always be kept in a cool place to 
keep them from melting. It is necessary to keep glycerin 
suppositories on ice. 

Vaginal and Urethral suppositories are also used. 

Vaginal suppositories are used as a means of applying 
local remedies to the cervix or walls of the vagina. A 
vaginal suppository is inserted in the same manner as a 
rectal suppository. The patient should lie flat on her back 


SYNCOPE 


with her knees flexed. Vaginal suppositories are larger than 
rectal suppositories. 

Urethral suppositories are much smaller and are shaped 
like a fine pencil. They are well lubricated and gently in¬ 
serted and pushed forward until the entire length has been 
introduced. 

SUPPRESSION* OF URINE 

See Urine, Suppression of. 

SYNCOPE 

Syncope is a condition of more or less complete uncon¬ 
sciousness due to anemia of the brain resulting from a sud¬ 
den fall of blood-pressure or failure of the heart to main¬ 
tain the circulation. 

The causes of the cerebral anemia may be: 

1. Lowered blood-pressure from the actual loss of blood 
as in a hemorrhage. 

2. Lowered blood-pressure from a weakened heart action 
which fails to maintain the circulation and allows the blood 
to accumulate in the veins. 

The weakened heart action may be the result of heart 
disease or of some temporary weakness resulting from de¬ 
pression of the nervous system as from the action of drugs, 
or fear, or worry, etc., or from physical exhaustion as from 
hunger, overexertion, or slight exertion when in a weakened 
condition. 

3. The lowered blood-pressure and weakened heart action 
may be due to stimulation of the vasomotor center resulting 
in a marked change in the distribution of blood in the 
three great reservoirs of the body—the skin, intestines, and 
muscles. In fainting, the skin is blanched and the body sur¬ 
face is cold because the blood vessels of the skin (and of 
the intestine) are contracted and the blood is driven into 
the dilated vessels of the muscles. This explains fainting 
as the result of severe pain, fright, joy, the sight of 
blood, or of an accident, all of which directly or reflexly 
stimulate the vasomotor center. 

The Symptoms .—A feeling of weakness and dizziness with 
roaring in the ears may precede the attack or the patient 
may suddenly feel weak and fall, unconscious, to the ground. 
The face and lips are blanched, the eyes are closed, the 
body surface is cold and clammy, the muscles are completely 
relaxed, the pulse is weak and small, and the respirations 
are shallow. 

The Treatment .—In most cases merely lowering the head 
between the knees or placing the patient flat on his back 
with the head low, will prevent an attack or revive a 


SYPHILIS 


patient. Fresh air should be admitted freely to the patient 
and all clothing should be loosened about the neck, chest, 
and waist. The respirations may be stimulated reflexly by 
giving inhalations of smelling salts or ammonia, by sponging 
or dashing cold water over the face and chest, or by fric¬ 
tion to the chest with the hand moistened in cold water, or 
by slapping the chest smartly with the hands or end of a 
cold wet towel. Heat applied for a brief period over the 
heart will increase the force and rate of the heart beat and 
stimulate the circulation. Heat applied to the neck, head 
and face will increase the supply of blood in the head and 
excite the mental activities. 

When consciousness is regained and the patient is able to 
swallow, water, aromatic spirits of ammonia, whiskey, or a 
hot drink should be given. 

After an attack of syncope, the patient should not attempt 
to sit up or walk about, but should lie quiet and at rest 
until the circulation is re-established. 

SYPHILIS 

See Iodides; Mercury; and Venereal Diseases. 

SYRUPS 

Syrups are preparations of drugs made with sugar and 
water. 


T 


TABES DORSALIS 

Tabes dorsalis, commonly called locomotor ataxia, is a 

syphilitic disease of the spinal cord, in which there is a 
chronic inflammation of the membranes and degeneration 
of the posterior roots and columns, the fibers of which con¬ 
vey sensation and impressions of muscle sense. Many phy¬ 
sical symptoms are produced and mental symptoms also may 
occur. 

Among the earliest symptoms are sharp, darting pains, 
“lightning-like pains,” which start in the ankle and instep 
and shoot up the leg to the thigh; then gradually the ataxia 
begins, inability to walk in the dark, or to move the legs 
unless each movement is watched and directed by sight. 
The patient may be able to stand erect, but upon closing 
the eyes while so standing, will sway and fall, because 
equilibrium can no longer be controlled through the muscle 
sense. This is known as Romberg’s sign, and is an im¬ 
portant symptom of this condition. There may be gastric 
pains and disturbances and sudden attacks of vomiting. 
Urinary and bladder disturbances may also be present. The 
pupils do not react to light and there are other reflex 
changes. Mentally the patient may be disordered, have hal¬ 
lucinations and delusions, be depressed and gradually de¬ 
teriorate. 

Nursing procedures. This is a disease of slow progress 
and prolonged course, and remissions may occur which always 
bring great hope to the patient and the family. For a long 
time the patient may be able to get about with the help of a 
cane and later with crutches, but gradually he becomes unable 
to stand and finally is helpless and must be cared for in bed. 
The usual measures of care and observation must be given 
as the symptoms make them evident. 

TABLETS 

Tablets are dried powdered drugs which have been com¬ 
pressed into small discs. They are usually prepared in an 


T^GNIACIDES 


aseptic manner so that they can be given hypodermically. 
Tablets are very easily dissolved. 

T.ENIACIDES 

Taeniacides are drugs which destroy or remove tape worms. 

Tape worms are long flat worms which consist of many 
segments. They often inhabit the intestine as a result of 
eating meat or pork infected with their eggs. 

See Anthelmintics. 

TAKA DIASTASE 

This is a starch digesting ferment formed by the action 
of a mold upon wheat bran. It is named after its discov¬ 
erer, Takamine, a Japanese. 

Taka diastase is very powerful and efficient, but it only 
acts in the stomach before the normal amount of acid is 
secreted. The action of starch digesting ferments is usually 
destroyed by the acid in the stomach. 

TALCUM 

This is magnesium silicate and is used as a bland soothing 
dusting pov/der. 

TANNIC ACID OR TANNIN 

Tannic acid is an organic acid which is found in a great 
many vegetable substances. It is obtained from powdered 
nutgall or oak gall. Tannic acid is very closely related to 
gallic acid, which is tannic acid combined with water. 

Local action: Applied to the skin, to a wounded surface 
or to an ulcer, tannic acid contracts the tissues by coagu¬ 
lating or hardening their cells. If applied to a bleeding 
point, it stops the bleeding. 

Internal Action: In the mouth: It has a harsh bitter 
taste, and makes the mouth feel dry by contracting the 
mucous membrane. 

In the stomach: It precipitates the protein of the food 
which is then not readily digested. 

In the intestines: It contracts the mucous membrane, 
thereby checking its secretions and making it less susceptible 
to impulses that start peristalsis, which is then lessened, 
and the bowels are constipated. 

Poisonous Effects 

Tannic acid is not a strong poison. Large doses often 
cause nausea, vomiting and diarrhea. 

Uses 

j Xo check excessive secretion of the alimentary tract, 
as in diarrhea. 


TAR 


2. To check excessive secretion and swelling of mucous 
membranes, as in the diseased condition of the mouth in 
mercury poisoning. 

3. To prevent bed sores by hardening the skin. 

4. As an antidote to various metallic and alkaloid poisons. 

5. It is often given as an astringent irrigation in the colon 
and vagina. 

Administration 

For a local effect it should be given in the form of an oint¬ 
ment or a lotion. 

For its effect in the stomach, it is best given in powder 
form. 

For its effect in the intestines, it is best given in pill 
form. 

Preparations 

Tannic Acid; dose 2 to 10 grains. 

Troches of Tannic Acid; dose x grain. 

For Local Use: Glycerite of Tannic Acid. 

This contains 20 per cent, of tannic acid. 

Tannic Acid Ointment. 

This contains 20 per cent, of tannic acid. 

Styptic Collodion. 

This contains 20 per cent, of tannic acid. 

TANNIN 

See Tannic Acid. 

TANNINS 

Tannins are substances whose chemical composition has 
not yet been determined, but they seem to be acids. They 
are found in the bark of many trees, in witch hazel and 
other plants. They form insoluble precipitates with alka¬ 

loids and proteins, and are therefore used principally as 
astringents. 

TAPE WORMS 

See T^niacides. 

TAR (PIX LIQUIDA) 

Tar is a black, semi-solid, sticky substance of a peculiar 
characteristic odor and taste. It is an oleoresin, obtained 
from the wood of various species of the pine tree. 

When tar is distilled, it forms the oil of tar, an oily 
liquid, and a solid black residue called pitch. 

Tar consists of a number of substances; the following are 

the most important ones: cresote, pyroligneous acid, wood 

alcohol, and a number of other compounds. 

Local action: Tar is used principally as an antiseptic and 
irritant in skin diseases. It usually causes considerable in- 


TARTAR, CREAM OF 


flammation. When the skin becomes severely inflamed, the 
fact should be reported to the physician. Tar should be 
applied with great care to the face and parts of the body 
where the skin is tender. 

Internally, it is principally used as a stimulating expecto¬ 
rant, especially in chronic bronchitis. It is occasionally used 
to destroy intestinal worms, and as an intestinal antiseptic. 

Preparations 

Oil of Tar; dose i to 5 minims. 

Syrup of Tar; dose 1 to 3 drams. 

This contains 7^4 per cent, of tar. 

Tar Ointment. 

This contains 50 per cent, of tar. 

TARTAR, CREAM OF 

See Saline Purgatives. 


TARTAR EMETIC 

See Emetics. 

TARTARIC ACID 

Tartaric acid is the acid of grape juice. Its action is 
similar to that of acetic acid. 

It is principally used to increase the flow of urine, in 
which it is excreted as alkaline carbonates. 

It is also used as a laxative, and it is an ingredient of 
the seidlitz powder. 

Tartaric acid is usually given in the form of grape juice, 
as a cooling refreshing drink. As a diuretic or laxative, its 
various salts such as potassium tartrate, etc., are preferred. 


TEA 

See Caffeine. 

TEETH, CARE OF 

See Mouth and Teeth, Care of. 

TERPIN HYDRATE 

Terpin hydrate is a colorless crystalline substance made 
from the oil of turpentine, by the action of nitric acid, 
alcohol and water. 

Terpin hydrate is used principally as an expectorant, as 
an antiseptic in gonorrhea, and in inflammation of the 
bladder. Dose 1 to 3 grains. 

TESTICLE 

This is the male organ of generation and corresponds to 
the ovary. It consists of the testis proper which manu- 


TESTICLE 


factures the spermatozoa, and the epididymis which is 
really a series of canals collecting the sperm from the 
glandular substance of the testes. These tubules, or canals, 
unite to form a single duct, the vas deferens, which carries 
the testicular product to the seminal vesicles, small pouches 
situated behind the prostate which open into the floor of 
the prostatic urethra together with the openings of the 
prostate gland. The prostate gland lies in front of the 
bladder surrounding the prostatic urethra and secretes the 
fluid which nourishes the spermatozoa and gives the seminal 
fluid its characteristic qualities. 

While the great majority of these cases will be handled 
by orderlies and trained attendants, circumstances may arise 
which will necessitate that they be cared for by skilled 
nurses. 

Acute Inflammation of Testicle (and Epididymis) 

Probably the most common cause of the acute inflammation 
is gonorrhea affecting the epididymis mainly, although it 
may be secondary to certain chronic diseases such as gout, 
or trauma from urethral instrumentation. 

Symptoms. —There is pain, swelling, tenderness of the epi¬ 
didymis, and systemic symptoms of anorexia, fever, and 
general malaise. 

Treatment. —The patient is ordered to bed, and the testicle 
is elevated by placing beneath the scrotum broad strips of 
adhesive plaster which are fastened to the shaven thighs. 
Local applications to the scrotum may be made in the form 
of heat or cold. Probably the application bearing heat 
which is lightest in weight is the flaxseed poultice. If ice 
is used it should not be left on continuously, but on for two 
hours and off for one. An enema should be given daily, and 
the patient forced to drink water in large amounts. When 
the condition is due to gonorrhea, the patient should be 
placed upon individual precaution. After the acute symp¬ 
toms have subsided, the patient may be allowed up, but 
the scrotum should be firmly supported by a suspensory 
for some time. 

Chronic Inflammation of Testicle (and Epididymis) 

These are secondary to acute inflammations, or due to 
syphilis or tuberculosis. If syphilitic in nature the patient 
is given anti-syphilitic treatment in the form of mercury 
and salvarsan. If tuberculous, the best procedure is op¬ 
erative. 

Symptoms. —The pain is not so severe as in acute inflamma¬ 
tions. In the cases of tuberculosis, there may be a sinus in 
the scrotum discharging pus from the diseased epididymis. 

Treatment of Tuberculosis. —Tuberculous epididymitis, 


TEMPERATURE 


when only one side is involved, is treated by orchidectomy 
(excision of the affected testicle). These cases require no 
special nursing care except that they should be placed upon 
individual precautions and kept out in the open air as much 
as possible. 

Hydrocele 

Lying in front of the testis and epididymis there is a 
small sac called the tunica vaginalis. This may become filled 
with fluid causing a hydrocele of the tunica vaginalis. 
As a rule it is not painful but uncomfortable because of 
its mere mechanical presence. 

Palliative Treatment. —In this procedure a needle or a 
trocar and cannula are inserted into the hydrocele sac and 
the fluid withdrawn. After most of the water has been 
tapped, some surgeons reinject an irritating fluid, such as a 
mild solution of carbolic and iodine, trusting that the irri¬ 
tation will cause the obliteration of the sac of the tunica 
vaginalis. 

Operative Treatment. —The operative procedure may be 
done under novocaine. The scrotum is washed with green 
soap, alcohol and ether. The skin of the scrotum is anes¬ 
thetized. The distended tunica is delivered into the wound, 
incised, part of it cut away, and the remainder sutured 
behind the testicle proper, destroying the sac. 

Post-operative Treatment. —The scrotum is supported 
upon a bridge and a moderate amount of pressure is applied 
to it to prevent post-operative bleeding. 

Varicocele 

Lying in the scrotum along with the spermatic cord is a 
plexus of veins. These very often become hypertrophied or 
increased in size and number, occasionally causing pain and 
a dragging sensation in the scrotum. This may be remedied 
by partially excising the veins through the scrotum, or just 
above the external abdominal ring. The only post-operative 
care is the support of the testicles by an adhesive bridge, 
and the wearing of a suspensory bandage subsequently. 

New Growths of Testicle 

The testicle, like the ovary, may be a location for cysts, 
spermatocele, dermoids, or carcinoma. In the cases of 
cancer, a radical excision of the testicle together with the 
vas deferens and the lymph glands draining these regions 
is performed, but the operation is attended with very 
much shock, and the mortality is extremely high. 

TEMPERATURE 

The body temperature may be ascertained by placing the 
thermometer in the mouth, the axilla, groin, rectum, or 


TEMPERATURE 


vagina. The temperature sought is that of the interior 
of the body uninfluenced by contact with clothing, air, or 
moisture, etc., so the thermometer must be placed where it 
can be completely surrounded by body tissues and where 
there are large blood-vessels and a free circulation of blood 
near the surface. The nearer these conditions are ap¬ 
proached, the more accurate the temperature taken will be. 

Departure from the Normal Temperature. —Slight varia¬ 
tions from 98.6° F. are not usually considered abnormal— 
variations within the limits of from 97 0 to 99 0 are usually 
not significant. Apart from the deviations indicated above, 
compatible with health, any departure from the normal tem¬ 
perature indicates that there is something wrong in the 
body. The elevation of temperature, however, is not always 
an index of the seriousness of the disease, for it may be 
higher in the shorter, less serious or fatal infections than 
in the most fatal. For instance, the temperature in ton¬ 
sillitis is frequently higher than in diphtheria, and in some 
fatal infections there may be no elevation at all. A pro¬ 
longed high temperature is always very serious. Recovery 
seldom occurs at a temperature above 107° F. 

The following classification is commonly used to describe 
the various degrees of temperature: 


Hyperpyrexia . 
High fever ... 
Moderate fever 
Low fever ... 
Subfebrile 

Normal . 

Subnormal 

Collapse . 

Algid collapse 


105° 

F. 

and over 

103° 

to 

105 0 F. 

IOI° 

to 

103 0 F. 

100° 

to 

101 0 F. 

99 ° 

98.6 

to 

0 F. 

ioo° F. 

97 ° 

to 

98.6° F. 

95 ° 

to 

97° F. 


below 95 0 F. 


The extremes of these temperatures, if maintained, are 
fatal to life. Even a slight elevation of temperature—99 0 
to 99.6° F.—occurring persistently every afternoon or eve¬ 
ning, may be, and frequently is an early symptom of such 
a serious disease as tuberculosis. 

In taking the temperature by mouth, place the end of the 
thermometer containing the mercury under the tongue, be¬ 
cause here it will be close to large arteries. See that the 
lips are kept tightly closed and that the patient breathes 
through the nose only. The mouth should be thoroughly 
clean. Leave the thermometer in this position until the 
mercury reaches a constant height, but do not leave it 
longer than necessary. The time will depend upon the 
thermometer used and varies from two to five minutes. The 











TEMPERATURE 


best grade of thermometer will register in one-half minute, 
but as the mouth contains air derived from the exterior, 
the lips must remain tightly closed for at least two minutes 
to allow it to warm up to the body temperature. The nor¬ 
mal temperature of the mouth is 98.6° F. 

The Axillary Temperature. —The temperature is sometimes 
taken by axilla when it cannot be taken by mouth because 
it is convenient, hygienic and occasions little discomfort or 
exertion to the patient. Before placing the thermometer in 
position see that the axilla is free from moisture or per¬ 
spiration, but do not rub the part because the friction may 
increase the temperature and make it inaccurate. See 
that the bulb is placed securely in the axilla and that it is 
completely enclosed by the body tissues by placing the arm 
over the chest with the fingers on the opposite shoulder. 
Do not allow the clothing to come in contact with the 
thermometer. It must remain in position ten minutes. 

For infants, the groin temperature is sometimes taken. 
The thigh must be well flexed over the abdomen. Ten 
minutes are required for registration. 

The axillary and groin temperatures are usually about one- 
half degree lower than that of the mouth. 

The rectal temperature is the most reliable and is generally 
used for very ill or toxic patients, for infants, children, 
restless and delirious patients. This method cannot be used 
after rectal operations, or when the rectum is diseased, in¬ 
flamed or not perfectly clean. Oil the bulb before inserting 
it to prevent irritation—irritation is not only a discomfort, 
but it draws an increased supply of blood and therefore heat 
in the part. It also stimulates the muscles of the rectum to 
expel the thermometer. Insert the bulb about two inches. 
The rectal temperature is usually from one-half to one 
degree higher than that by mouth. 

Never leave children or restless, delirious or hysterical pa¬ 
tients alone with a thermometer, for their restless move¬ 
ments are apt to displace or break it. Hysterical patients, and 
sometimes others, also, occasionally try to mislead the 
nurse into thinking that their temperature is elevated by 
“sucking” the thermometer or holding it on a hot-water 
bag or in hot fluids, etc. 

The Care of Thermometers. —Thermometers, whether used 
for mouth or rectal temperatures, should be rendered scrupu¬ 
lously clean and free from infection after use by washing 
thoroughly in cold water and allowing them to stand in an 
antiseptic solution (usually bichloride of mercury 1 to 
2,000) long enough to disinfect them. 

All thermometers should be tested and compared at regu¬ 
lar intervals with a standard thermometer, because the glass 


THEOBROMINE 


gradually contracts so that, after a time, the readings are 
inaccurate, being slightly too high. 


TETANUS ANTITOXIN 

See Serums. 


TETANY 

See Thyroid Gland, Diseases of. 


TETRONAL 

Tetronal is a white powder. Its effects are similar to 
those of trional and sulphonal. It is given in the same 
way, but it is not often used because it is more poisonous. 
Dose 15 to 30 grains. 

See Sulphonal. 

THEOBROMINE 

Theobromine is a white powder, an alkaloid, obtained 
from the seeds of the Theobroma cacao, the chocolate 
tree of South America. It is very closely related, chem¬ 
ically, to caffeine. Its action is similar to that of caffeine. 

Internal Action.—In the mouth: It has a somewhat 
bitter taste. 

In the stomach and intestines: It increases the secre¬ 
tions and peristalsis; often causing nausea, vomiting and 
frequent movements of the bowels. 

Action on the heart: It makes the heart beat stronger 
and faster. It also contracts the blood vessels. The pulse 
is therefore stronger and faster. 

Action on the muscles: Theobromine increases the con¬ 
tractions of all the muscles. 

Action on the kidneys: Theobromine and its salts are 
excellent diuretics. They increase the flow of urine, by di¬ 
rectly increasing the activity of the kidney cells. In this 
way, they remove fluid from the tissues and from the abdo¬ 
men, relieving the edema of the extremities and ascites. 

Excretion 

Theobromine and its salts are rapidly eliminated from 
the body mainly by the kidneys; usually in a few hours. 

Poisonous Effects 

Since theobromine is rapidly excreted, it very rarely pro¬ 
duces poisonous effects. When poisonous symptoms do 
occur, they are the same as those produced by caffeine. 

Administration 

Since theobromine and its salts are rapidly eliminated, 
they are best given in small doses, frequently repeated 
(about every two hours), when a continuous effect is desired. 


THERMOCAUTERY 


Preparations 

Theobromine; dose 5 to 15 grains. 

This preparation is apt to upset the stomach. 

Theobromine Sodium Salicylate (Diuretin) ; dose 5 to 
15 grains. 

This preparation is very frequently given as a diuretic, 
because it is more readily dissolved than the others. 

See Caffeine. 

THERMOCAUTERY 

The application of the Paquelin thermo-cautery, as a rube¬ 
facient, consists in an application of dry heat made by 
passing the red-hot platinum tip of the cautery to and fro 
over the affected part until it becomes well reddened. Some¬ 
times the skin is lightly flicked with the red-hot tip. The 
Paquelin cautery consists of a hollow, platinum tip which 
is screwed on to a hollow metal rod or cylinder, and a 
handle which in turn is connected by rubber tubing to one 
arm of a metal container. To another arm of this con¬ 
tainer a rubber tubing and a soft rubber bulb covered with 
netting are attached. In the metal container there is a 
small sponge which is saturated with benzine before using 
the cautery. By squeezing the rubber bulb the fumes of 
benzine may be forced along into the platinum tip. When 
the tip is . heated in a flame it may be kept constantly at 
the required temperature by simply squeezing the rubber 
bulb gently so as to keep the tip supplied with benzine fumes. 
The metal container is provided with a valve by means of 
which the escape of the fumes may be prevented when the 
apparatus is not in use. 

The cautery is used for the relief of inflammation and 
pain in sciatica and other painful nerve trunks, in lumbago, 
torticollis and other forms of muscular rheumatism. 

The Method of Procedure. —The treatment is usually 
given by a doctor. The nurse’s duties are to prepare the 
patient and the apparatus and to keep the platinum tip sup¬ 
plied with benzine iumes and at the right temperature. 

To prepare the patient place him in the most suitable and 
comfortable position. Arrange the bedclothes neatly so as 
to avoid unnecessary exposure. An extra blanket may be 
necessary to protect and keep the patient warm. Reassure the 
patient that there is no danger of burning or pain, but in¬ 
struct him to keep still. Usually it is best not to allow the 
patient to see the red-hot tip except when, as sometimes 
happens, the treatment is given for its possible psychic effect. 

Before taking the apparatus to the bedside it should be 
examined to see that it is intact and in good working 
order. When the treatment is being given the platinum tip 


THORACIC ASPIRATION 


should be kept red-hot, not white-hot. Avoid forcing too 
much air into the air bulb or reservoir, so as to prevent it 
bursting. As a rule the heated platinum tip is not allowed 
to touch the patient. As a precautionary measure, in case 
of restlessness, some doctors prefer to have a layer of 
gauze over the part. Sometimes, however, the skin is 
touched lightly along the path of the nerve, etc., with the 
heated tip. Avoid touching anything with the heated tip, not 
only because it will burn whatever it touches, but because 
when heated it is soft and easily dented. Never cool the 
tip by putting it in water. When the treatment is completed, 
rearrange the bedclothes and make the patient comfortable. 
Before putting the apparatus away see that the valve is 
closed so as to prevent the evaporation and loss of any 
benzine which may remain. 

THERMOMETRY 

There are two scales used in thermometry, the Fahrenheit 
and the Centigrade. The former is generally used. How¬ 
ever, since many of the scientific calculations are made using 
the Centigrade scale it is wise for the nurse to understand 
how to translate one to the other. 

Centigrade has o° as the freezing point and ioo° as the 
boiling point, while Fahrenheit has 32 0 as freezing point and 
212 0 as boiling point. To change Fahrenheit to Centigrade 
it is necessary to subtract 32 from 212 in order to make the 
freezing points correspond. This would read 212— 32 = 
180 0 F. = ioo° C.; hence a degree Centigrade represents 
5/9 of a degree Fahrenheit. 

To change Centigrade to Fahrenheit it is necessary to 
remember that every Fahrenheit degree is 9/5 times as large 
as the Centigrade and the addition of 32 0 must also be 
made. For example: Change 105° F. to Centigrade: 
(105° — 32 0 ) X 5/9 = 41° C. Change 50° C. to Fahren¬ 
heit: (50° X 9/5) + 32° = 90° -f 32 0 = 122 0 F. 

See Temperature. 

THORACIC OR CHEST ASPIRATION 

A chest or thoracic aspiration is the withdrawal of fluid 
from the pleural cavity. 

The treatment is indicated when resolution or absorption 
of fluid fails to take place and when its accumulation causes 
pain, dyspnea and other symptoms of pressure. Frequently 
removal of part of the fluid is sufficient to enable the body 
to complete its absorption. 

Dangers involved in a Chest Aspiration. —(1) Shock; (2) 
puncture of the intercostal or pulmonary blood vessels with 
a severe hemorrhage which may prove fatal; (3) puncture 


THORACIC ASPIRATION 


of the lung or of the diaphragm; (4) fatal syncope due to 
the withdrawal of fluid and the sudden relief of pressure on 
the heart, blood vessels and lungs, etc.; (5) convulsions have 
occurred, probably of reflex origin. 

Important Factors to be Remembered in Giving the 
Treatment. — (1) That the treatment involves one of the 
vital organs, the function of which has been interfered with; 
(2) the proximity of the heart, the function of which may 
also have been interfered with; (3) the dangers involved; 
watch the patient’s color, pulse and breathing. Watch for 
coughing (which may result from pricking the visceral layer 
of the pleura), or expectorating, and watch for any symp¬ 
toms of syncope; (4) the danger of further infection or of 
forcing air into the pleural cavity. 

Method of Procedure. —The nurse’s duties are to prepare 
the articles necessary for the treatment, to prepare the 

patient, to watch him during the treatment, and to assist 
the doctor. 

The required articles are a rubber sheet to protect the 

bed; sterile sheets to render the surrounding area sterile, 
alcohol or iodine and sterile cotton to disinfect the skin, 
a sterile hypodermic needle and syringe and cocaine 2 per 
cent, for local anesthesia, sterile gloves and powder for 

the doctor, a sterile dressing and adhesive or a collodion 
dressing and the aspirating set. This consists of a gradu¬ 
ated five- to eight-pint glass bottle provided with a rubber 
stopper in which there is a metal tube with two branches, 
each provided with stopcocks. To each branch is fitted a 
piece of rubber tubing provided with metallic ends. The 

sterile aspirating needle fits the metallic end of one piece of 
tubing and through the other air may be exhausted from 
the bottle, with an exhaust pump, leaving a vacuum in the 
bottle into which the chest fluid will readily flow. 

When the air is exhausted from the bottle both stopcocks 
must be closed, but before starting the preparation for the 
treatment the apparatus must be tested to be sure the chest 
fluid will flow into the bottle. You test the apparatus by 
placing the tubing, which is to be attached to the aspirat¬ 
ing needle, into a glass of water and opening the stopcock 
of that branch only; if the water runs into the bottle readily, 
the chest fluid will also do so when the needle is inserted 
into the pleural cavity and attached to the tubing. 

The position of the patient is important. To lessen the 
danger of shock, of fainting or of fatigue, it is wise to have 
the patient lie on his unaffected side in a semi-recumbent 
position, on the side of the bed most convenient for the 
doctor. The arm of the affected side may be held above 
the head or held forward with the hand on the opposite 


THORACIC WALL 


shoulder. The position must Be comfortable, involving no 
strain or exertion. Frequently the treatment is given with 
the patient sitting on the side of the bed, his feet resting 
on a stool or rung of a chair, his arms resting on a pillow 
on the back of the chair. Sometimes it is given with the 
patient leaning forward on a bed tray. He should be 
warmly clad (that is, he should wear slippers and stockings 
and his body and lower extremities should be well wrapped 
in gray blankets) to prevent chilling and lessen the danger 
of shock. Only the necessary exposure should be per¬ 
mitted. 

The skin where the puncture is to be made is disinfected. 
Punctures are usually made in one of the following spaces: 
(i) in the sixth or seventh interspace in the middle axillary 
line or (2) in the seventh or eighth interspace just outside 
the angle of the scapula. 

The needle is injected midway between the ribs to avoid 
the intercostal blood vessels and during inspiration when the 
spaces are wider. The greatest precaution should be taken 
to prevent the entrance of infection or of air. 

After the treatment the patient must remain quietly in 
bed, in the recumbent position and no exertion or sudden 
movements should be allowed. The sputum should be 
watched for the presence of blood. Blood in the sputum 
following a chest aspiration may result from injury to a 
blood vessel. 

THORACIC WALL, INJURIES TO 

Injuries to the thoracic wall may be the result of bullets, 
stab wounds, or compound fractures of the ribs. The latter 
occur quite often following severe compressions of the chest, 1 
such as occur in “run-over” accidents. Wounds of the chest 1 
may be superficial, involving skin and muscle, or deep, pen¬ 
etrating the pleural cavity. The dangers of the last named 
variety are the complications of pneumo-thorax (air in the I 
pleural cavity with collapse of the lung), hemo-thorax, a 
condition in which the pleural cavity is filled with blood j 
due to injury of the blood vessels of the lung itself; or, the 
possibility of a superimposed infection of the pneumo- 1 
thorax (pyopneumothorax). 

Treatment of Injuries to the Thoracic Wall. —This is 
usually surgical in nature. The wound is thoroughly cleansed 
and the hemorrhage controlled. If any of the ribs have 
been fractured, they are securely strapped and the patient 
kept in bed for a few days. Many of these cases, espe¬ 
cially those with deep, penetrating wounds, develop serious 
complications, such as pneumonia, or infection of the pleural 
cavity (empyema). 


THORIUM 


THORIUM 

See Radium. 

THORNAPPLE 

See Stramonium. , 

THROAT, FOREIGN BODIES IN 

It sometimes happens that a fish bone gets stuck in the 
throat, and it is impossible to reach it with the finger. In 
that case a raw egg swallowed quickly will generally carry 
it into the stomach. If a pin, a piece of glass, or any for¬ 
eign body with a sharp edge is swallowed by mistake, do 
not give an emetic, but make your patient eat solid food, as 
potatoes or bread, so that the object may become embedded in 
the food and carried out of the system without injuring the 
intestines. 

THROMBOPHLEBITIS 

See Phlegmasia alba dolens. 

THROMBOSIS (POST-OPERATIVE) 

This may follow in the path of a phlebitis, and simply 
means the occlusion of the lumen of the vein with a blood 
clot. The same condition may occur in arteries. The 
symptoms are practically those of a phlebitis. The danger 
of these cases lies not so much in thrombosis itself, but in 
the fact that these thrombi may give rise to small particles 
of blood clots (emboli) which invade the blood stream and 
localize in any part of the body. The symptoms and physical 
signs depend on the area in which these emboli have lodged. 
If they should localize in the brain, paralysis may ensue, if 
in the central artery of the retina, blindness, if within the 
coronary artery of the heart, immediate death. A glance 
at these possibilities is certainly proof that a thrombosis is 
potentially a dangerous operative complication. 

Treatment. —"The acute condition is treated practically the 
same as a phlebitis, with the exception that the local applica¬ 
tions vary, some using ice compresses over the veins, others 
a 20 per cent, icthyol ointment, some the electric pad. All 
surgeons believe in absolute rest of the part involved. It 
is a good practice to keep the weight of the bed clothing 
away from the affected area, by means of a wooden or 
metal cradle. When all the acute inflammation has subsided, 
the patient should not be allowed up and out of bed until 
a good firm pressure bandage has been applied. In a leg 
case, the bandage is wound from the ankle upward to the 
knee. The patient should be warned that even after leaving 
the hospital, or home, a rubber stocking properly fitted 
should be worn for a long period of time. 


THYROID EXTRACT 


Of course when this condition involves the superficial veins 
it is not so very serious, but it has been known to choke off 
the femoral artery, the main channel through which the 
lower extremity gets its supply of blood. This might result 
in gangrene with subsequent amputation of the leg and 
thigh. These severe post-operative complications are for¬ 
tunately rather rare. 

See Phlebitis. 


THYMOL 

Thymol is a chemical substance which resembles carbolic 
acid or phenol, chemically. It is principally used as an 
antiseptic, but it also has a specific destructive action on 
hook worms. 


Administration 

The bowels are thoroughly moved with a brisk cathartic 
the day before, and the morning before administration 
about 5 to 15 grains of thymol is given, and the dose is 
then repeated several times. About half an hour after the 
last dose, a dose of castor oil should be given. 

See Anthelmintics. 

THYMUS 

Thymus is a powder made from the fresh thymus of the 
calf. It is a gland situated in the chest, behind the sternum 
and probably regulates the growth of the child. It is used 
in the treatment of rheumatism and rickets. 

THYROID EXTRACT 

Thyroid extract is a powder made by grinding up the 
thyroid glands of sheep. Its active principle is a substance 
called iodothyrin. 

The thyroid gland is a ductless gland which secretes a 
substance into the blood. This substance regulates the 
growth and development of the body. Thus, children who 
have a poorly developed thyroid gland are stunted in their 
growth, they develop pads of fat in the neck and other 
parts of the body, their intelligence is lessened, and they 
are dull and stupid (Cretinism). 

The administration of thyroid extract to such children 
is followed by startling improvement of their intelligence, 
growth and development. 

Old people in whom the thyroid gland has atrophied, so 
that its secretion is very much lessened, often suffer from 
similar symptoms; such as dullness of mind and drowsiness 
(myxedema). 

These symptoms are relieved by the administration of 
thyroid extract. Dose is 3 to 10 grains. 


THYROID GLAND 


Poisonous Effects 
* ‘Hyperthyroidism’ ’ 

When the thyroid gland secretes into the blood more 
substances than necessary, the following symptoms are pro¬ 
duced. These symptoms frequently occur from certain en¬ 
largements of the thyroid gland (exophthalmic goiter or 
Graves’ disease). 

1. Rapid loss of weight. 

2. Rapid, thready pulse. 

3. Nervousness. 

4. Bulging eyeballs (exophthalmos). 

5. Diarrhea. 

Thyroid extract is frequently taken to reduce weight in 
obesity. It is a dangerous remedy, as its continued use 
often produces the symptoms of hyperthyroidism. 

THYROID GLAND 

The thyroid is a small, flat, ductless gland lying against 
the fore part of the trachea, below the thyroid cartilage. 
It is of a deep red color, weighs about an ounce, and con¬ 
sists of two lateral lobes connected at their lower parts by 
an isthmus. The lobes are broader below and taper to a 
point above. Small masses of thyroid tissue are sometimes 
found along the trachea as far down as the heart. They 
are called accessory thyroids. Comparatively little is known 
about the action of the thyroid secretion, but much clinical 
evidence supports the theory that it is necessary for the 
continuance of normal metabolism. 

THYROID GLAND, DISEASES OF 

The word goiter is familiar to the lay mind, and even 
a layman distinguishes two types—the one in which there 
is simply an enlargement of the thyroid gland, and the other 
in which there is enlargement complicated by definite nerv¬ 
ous symptoms. Just as in the pituitary, there may be an 
increase or perversion of the thyroid secretion known as 
hyperthyroidism, or there may be also a diminished secre¬ 
tion. If it occurs before the age of puberty, or dates from 
birth, cretinism results, or if it occurs in adult life, myx¬ 
edema may occur. 

Cretinism. —These children have a diminished thyroid se¬ 
cretion. As a rule they are fat and pudgy with coarse, 
sparse hair, unable to walk, and have a subnormal tempera¬ 
ture; their mentality is practically nil. Thyroid extract 
given to these unfortunates often transforms them at least 
from an animal stage to a point where they can protect 
themselves sufficiently to exist. 

Myxedema. —Very often patients in adult life begin to 


THYROID GLAND 


show signs of mental sluggishness with a slow reaction time, 
and their faces become coarse and mask-like. In other 
words, they are somewhat like a cretin. Thyroid extract or 
any preparation of the thyroid gland, given by mouth, helps 
these people markedly. 

Goiter. —Any enlargement of the thyroid gland that is 
chronic in nature is spoken of as a goiter. The symptoms 
which come from the goiter are mechanical, and result from 
pressure of the enlarged gland upon those structures which 
it might compress. From pressing on the wind pipe 
(trachea) it may give rise to a cough, or it may cause diffi¬ 
culty in swallowing, by pressure on the gullet (esophagus). 

Treatment of Goiter. —Goiter may be treated medically or 
surgically. Some cases respond to the internal administra¬ 
tion of potassium iodide. X-ray, when given in graduated 
doses, sometimes reduces the size of the gland. But if the 
goiter is large and the symptoms are aggravating and per¬ 
sistent, surgery is practically the only measure which will 
afford relief. 

Ante-operative Treatment. —On the morning of operation 
the neck should be shaved, cleansed with green soap and 
water, followed by alcohol and ether, and a sterile dressing 
applied. 

Post-operative Care. —The patient should not be permitted 
to talk any more than is necessary for at least a week. 
Attention should be paid to the character and tone of the 
voice. The reason for this is obvious, when it is recalled 
that the nerves which partially control the vocal chords lie 
close to the gland and may have been injured or cut during 
the operation. This is indeed a serious complication, because 
if they are cut it will result in permanent alteration of the 
patient’s voice. 

It should also be remembered that occasionally patients 
run a high temperature, rapid pulse, and may even be de¬ 
lirious. The syndrome is often spoken of as acute thy- 
roidism. This condition should be treated with ice packs, 
but this will be discussed at greater length in the treatment 
of exophthalmic goiter. 

Exophthalmic Goiter 

Symptoms. —Patients with exophthalmic goiter as a rule 
are recognized immediately by the fact that their eyes are 
prominent and protrude, and that they are extremely nervous. 
Their pulse rates vary from 90 to 120, and sometimes even 
higher. In other words, they have what is called tachy¬ 
cardia. Their skin, as a rule, is moist, and they perspire 
freely. A very definite swelling of the thyroid gland is 
often visible. These symptoms all point to a poisoning 


THYROID GLAND 


from either an increased amount, or a perversion of the 
thyroid secretion. It does not take much imagination to 
realize that, above all else, these patients need peace and 
quiet. They are nervous in the extreme. Association with 
others, incessant talking, and noises tend greatly to aggra¬ 
vate them and increase their pulse rate. The keynote in 
the care of these patients is rest under ideal surroundings, 
and treatment administered so tactfully and carefully that 
the shock to the nervous system will be as little as possible. 

Treatment.—Medical. —All cases of exophthalmic goiter 
should, as a rule, be treated medically at first. The treat¬ 
ment consists of rest in bed, complete isolation from society, 
a diet of high .caloric value with forced feeding, and the 
administration of sodium bromide to relieve the intense nerv¬ 
ous excitement. Some physicians give iodine internally, 
and some use thyroid extract. 

Surgical. —It is in the surgical treatment of hyperthyroid¬ 
ism that tremendous strides have been made. The patient 
at present is not operated upon the day after she enters the 
hospital. These highly nervous women are no longer sub¬ 
jected to the terror of being ridden directly to the operating 
room and arriving there with a pulse of 140; then, in their 
weakened condition, subjected to ether anesthesia and a 
shocking operation, with the result that having little stamina 
left, they usually succumb within twenty-four hours after 
a partial thyroidectomy has been attempted. 

Ante-operative Treatment. —In the treatment of these 
cases it cannot be emphasized too strongly that great tact 
and care should be utilized by the nurse in charge so 
as to gain the absolute confidence of the patient. The room 
which the patient is to occupy should be bright, well ven¬ 
tilated and airy, away from all noise such as street cars, 
and busy corridors. The patient should be kept continually 
in bed, not even being allowed lavatory privileges. The diet 
should be plentiful, an accurate account kept of the food 
ingested, and the caloric value figured accurately, because 
it is imperative that these cases be given 5,000 calories or 
more of food a day. The patient should be kept quiet on 
liberal dosage of bromides, even to the point of bromidism. 
Visitors should be few, and their period of stay limited. All 
depressing topics of conversatioh must be omitted. Any¬ 
thing which would arouse the excitement of the patient, such 
as dazzling headlines in the current newspapers, melodra¬ 
matic stories, and trashy magazines, must not be permitted. 
Since the slamming of windows and doors always causes a 
sudden shock to the patient, great care should be taken to 
see that it is not done. In other words, the medium in 
which the patient lives must be calm, serene and peaceful. 


THYROID GLAND 


As soon as the patient has sufficiently recuperated from 
the strangeness of hospital surroundings, and the pulse rate 
has fallen around 90, it is advi-sable to acquaint the patient 
with the fact that she is to prepare for operation. The 
anesthetist who is to give the anesthesia should be intro¬ 
duced; he should explain the operation of the gas mask, 
place it gently over the patient’s head, teach her how to 
breathe through it, and just what she is expected to do. 
He should visit her daily and rehearse the little act of 
psychologically anesthetizing the patient. In the meanwhile 
the nurse should prepare the neck as if the operation were 
really to be performed. The anesthetization of the patient 
when possible should be done in her private room, and as 
the patient has become accustomed to the anesthetist, the 
mask and the preparation of the neck by the nurse, it is 
possible that the actual day of operation may ' be kept 
secret from the patient. In other words, the gland may be 
stolen away, the patient little knowing that one of the 
rehearsals with the anesthetist is the day on which the 
operation is to take place. 

The anesthetic which is used is nitrous oxide and oxygen, 
and, in addition, the line of incision is usually first injected 
with novocaine, per cent. The operation is usually done 
in stages; that is, the blood supply to the thyroid is first 
lessened by the ligation of the superior thyroid arteries, and 
then the inferior thyroid arteries. This may be done under 
local anesthesia, or under gas and oxygen. The reason for 
the preliminary ligation is to diminish the blood supply of 
the thyroid. This simple procedure is very often all that 
is necessary, and with it the symptoms of hyperthyroidism 
abate, and the patient needs no further surgical treatment. 
If, on the other hand, the symptoms are not definitely 
improved, at least the blood supply of the gland is lessened, 
so that when the thyroid is removed, the hemorrhage will be 
materially decreased, the degree of shock less, and a speedy 
recovery of the patient assured. 

Post-operative Treatment. —The patient should be kept 
especially quiet and given plenty of fluid by rectum. Very 
often these patients are subject to a sudden rise in tempera¬ 
ture, sometimes as high as 106 degrees, and an increase in 
pulse rate that is rapid and thready. Their faces become 
pinched and covered with perspiration; they are apt to 
become delirious and die within a very short time. These 
symptoms are thought to be due to an acute hyperthyroidism. 
It has been found that as soon as these symptoms occur, 
they can be controlled by the use of the ice-pack. 

Occasionally, following the operation there may be a hemor¬ 
rhage from the operative wound. The bandage should be 


TINCTURES 


reinforced and the operating surgeon immediately summoned. 
More rarely a condition of edema of the glottis may develop. 
This is evidenced by difficulty in breathing, cyanosis of the 
patient, and a bubbling respiration. This condition demands 
immediate attention, often tracheotomy; and no time should 
be lost in summoning the medical officer in charge. 

Following any operation upon the thyroid, especially of 
exophthalmic variety, the patient should be given a prolonged 
rest in some quiet mountainous resort. The surroundings 
should be congenial, and the patient should not be permitted 
to return to her usual environment until the attending physi¬ 
cian feels assured that she can stand the strain. 

Tetany. —Occasionally after rather an extensive removal of 
the thyroid gland, a peculiar condition may result, namely 
that of tetany. This is presumably due to the fact that 
the parathyroid glands which are closely attached to the 
posterior surface of the thyroid have been partially removed. 

The symptoms of tetany are intermittent, bilateral spasms 
confined to the extremities. These paroxysmal attacks may 
be controlled by the administration of calcium lactate, about 
fifteen grains every three hours. 

TINCTURES 

Tinctures are dilute alcoholic extracts of drugs varying 
in strength from io to 20 per cent. The pharmacopeias 
of all countries now agree on 10 per cent, as the standard 
strength for tinctures of all powerful drugs. Tinctures 
of weak drugs are often 20 per cent, in strength. Tincture 
of iodine and tincture of iron chloride, which are not 
extracts, are alcoholic solutions and not real tinctures. When 
another fluid besides alcohol is contained in the tincture 
this is added to the name; for example, when the alcohol 
contains ammonia, the tincture is called an ammoniated 
tincture. 


TOBACCO 

Tobacco is the dried leaves of Nicotiana tabacum, a plant 
growing in tropical countries. It contains nicotine, a very 
poisonous volatile fluid alkaloid, and other substances. 

Tobacco is not used as a medicine, but it is habitually 
used as a luxury by many individuals. 

Tobacco, because of its nicotine acts like lobelia. It lessens 
the contractions of all the involuntary muscles. A strong 
cigar will often relieve an attack of asthma, by lessening 
the contractions of the involuntary muscles of the bronchi. 

It increases the peristalsis and often acts as an excellent 
cathartic. It increases the flow of urine. 


TONGUE, REMOVAL OF 

In persons who do not smoke habitually, tobacco often 
causes nausea, vomiting, headache, dizziness and weakness. 
In those who smoke habitually, it does not produce such 
effects. 

Poisonous Effects 

Nicotine is one of the most violent poisons known. It 
causes symptoms like those of lobelia poisoning, which come 
on very rapidly and cause death. 

Chronic tobacco poisoning is a frequent condition which 
follows excessive smoking. The symptoms are due to the 
nicotine which the tobacco contains. The patient usually 
complains of palpitation of the heart, he has a rapid irregu¬ 
lar pulse and is very nervous. 

TOLU 

See Balsam of Tolu. 

TONGUE, CARCINOMA OF 

Treatment of Inoperable Cases. —While all patients suf¬ 
fering from inoperable cancer are miserable, there are none 
who present such a horrible spectacle as those with a large 
fungating growth of the tongue. Unable to swallow, finding 
difficulty in breathing, suffering agonies, with an oral stench 
which is hardly bearable for themselves or others associated 
with them, they are entitled to all the sympathy possible. 
If nothing else can be done for these unfortunates they 
may be kept absolutely free from pain. The local pain is 
sometimes reduced by dusting the ulcerated areas with 
orthoform powder. It is applied before any food is taken. 
Morphine should be given liberally, with a little atropine to 
prevent its depressing effects. The foulness of the breath 
may be lessened by the continual use of mouth washes and 
mouth irrigations. If dyspnea becomes marked because of 
crowding of the larynx by the growth, tracheotomy may be 
necessary. If difficulty exists in swallowing, rectal feeding 
may be given. Feeding by stomach tube or nasal gavage is 
not practical, because the rubber tubes coming in contact 
with the growths cause excruciating pain. Occasionally, the 
proper use of radium and X-ray, in selected cases, will do 
much to give relief where the knife has failed. 

TONGUE, REMOVAL OF 

Ante-operative Preparation. —This consists of the usual 
cleansing of the mouth as already outlined in operations upon 
the jaw. 

Operation. —The anesthetic is administered intra-nasally. 
The mouth is kept open by a self-retaining gag. A heavy 
silk ligature should always be at hand for introduction 


TONSILS 


through the base of the tongue. This serves as a tractor, and 
even after the tongue has been removed the ligature is left 
in place, the free end being fastened either to the teeth, or 
identified by an attached pair of forceps that hang from 
the mouth. This ligature should remain in place for at least 
twenty-four hours after operation, for it is invaluable in con¬ 
trolling the base of the tongue should any serious hemorrhage 
occur. 

Post-operative Treatment. —In those conditions in which 
either half or the entire tongue has been removed, the treat¬ 
ment of the raw denuded surface of the floor of the mouth 
is what most concerns us. The desideratum, of course, is 
to render this area aseptic. To attain this end, some operators 
use balsam of Peru, which is applied as gently as possible. 
The dusting of iodoform powder is to be condemned, as iodine 
poisoning may result. Other surgeons prefer the use of 
mild antiseptic sprays. 

For about four days, the patient should be fed by enemata. 
Each morning the bowels should be washed out with a 
soap-suds enema followed by rectal feedings which are 
given, as a rule, every four hours. If the patient is very 
weak and emaciated, and demands more nourishment than 
can be given by rectum, a small stomach tube may be 
passed through the nostril into the stomach, and left in 
place. Some operators prefer that the patient be fed 
directly by mouth; a soft rubber catheter is passed along 
the normal side of the mouth permitting the patient to 
swallow the liquids which are poured slowly through the 
tube. Each feeding should be completed by the administra¬ 
tion of sterile water, and the tube withdrawn, after which 
the mouth should be thorough cleansed. Soft diet may be 
given as soon as the wound heals and swallowing without 
difficulty is possible. The patient should be permitted to 
sit up in bed as soon as possible, and so as to afford better 
drainage to the secretions which collect in the mouth, the 
head should be kept bent slighlly forward. These cases 
may be allowed up from bed on about the fourth day. 


See Pharynx. 


TONSILS 


TONSILLECTOMY 

Tonsils are removed very often, both because of a diseased 
condition and because of an increase in size, or hypertrophy. 
As a rule the operation is attended with very little risk 
and is performed under ether in children, and with local 
anesthesia in adults. 

Operative Treatment. —The patient, if a child, is placed 


TRACHEA 


under ether anesthesia in the dorsal position and the mouth 
held open by a self-retaining gag; an electric head lamp 
worn by the surgeon supplies the light. The tonsils are 
removed by one of several methods, either by blunt dissec¬ 
tion with a Sluter tonsillotome, or they are dissected out 
with scissors, and finally enucleated with a snare. The 
hemorrhage is controlled by the simple pressure of gauze 
sponges. If necessary, the bleeding vessels may be tied, or 
a sponge with a piece of tape securely attached may be left 
in the tonsillar fossa for twenty-four hours. After the 
operation has been completed, to further stop bleeding and 
cause the patient to regain consciousness as quickly as pos¬ 
sible, the neck and face are bathed with towels previously 
soaked in ice water. 

After Treatment. —While these cases are apt to ooze a 
little after operation, careful watch should be kept on the 
pulse, and if they are bleeding briskly, as evidenced by the 
constant expectoration of bright red blood, or the vomiting 
of large quantities of altered blood, the attending surgeon 
should be notified immediately, for cases of fatal hemor¬ 
rhage have been known to result. 

The diet should be liquid; ice cream being given to chil¬ 
dren, for the cold is gratifying to the throat, and the 
psychic effect cheering to their depressed spirits, and, in 
addition, the cream forms a protective layer to the denuded 
areas of the pharynx. The patient is kept indoors for a 
day or two to prevent catching cold. 

See Pharynx. 

TONSILLITIS 

See Pharynx. 

TORSION 

See Hemorrhage. 

TOURNIQUET 

See Amputation. 

TOXEMIA 

See Sepsis. 

TRACHEA 

The trachea, or windpipe, is a fibrous tube, about four 
and a half inches in length, and three-quarters of an inch 
from side to side. It lies in front of the esophagus and 
extends from the larynx on the level of the sixth cervical 
vertebra, to opposite the fourth or fifth thoracic vertebra, 
where it divides into two tubes,—the two bronchi,—one for 
each lung. 

The walls are strengthened and rendered more rigid by 


TRACHEOTOMY 


hoops of cartilage embedded in the fibrous tissue. These 
hoops are C-shaped and incomplete behind, the cartilaginous 
rings being completed by bands of plain muscular tissue 
where the trachea comes in contact with the esophagus. 
Like the larynx, it is lined by mucous membrane, and has 
a ciliated epithelium upon its inner surface. The mucous 
membrane, which also extends into the bronchial tubes, 

keeps the internal surface of the air-passages free from 
impurities; the sticky mucus entangles particles of dust 
and other matters breathed in with the air, and the inces¬ 
sant movements of the cilia continually sweep this dirt¬ 
laden mucus upward and outward. 

TRACHEOTOMY 

A tracheotomy is an incision into the trachea in order 
that a tube may be introduced therein, thus providing for 
the entrance and exit of air. This may be done either 

as an emergency measure following a thyroid operation in 
which the trachea has collapsed, when a foreign body has 

become lodged in the larynx so that respiration is embar¬ 

rassed, in acute edema of the glottis, or in obstruction 
asphyxia during the administration of an anesthetic. It 
may be employed as a preliminary measure to a removal of 
the larynx for cancer. The operation is either high or low, 
the high being preferable, because the trachea is more acces¬ 
sible; the low being done when the operator has to reach 
a foreign body which has fallen into one of the bronchii. 

Operation. —The patient is placed upon the back with a 
sand bag underneath the neck so as to make the trachea 
as prominent as possible. An incision is made in the mid¬ 
line, the muscles separated, the trachea exposed, incised, and 
a tracheotomy tube introduced. These tracheotomy tubes 
are of various types, but the one generally used is similar to 
that shown in the figure. It is very important, after the 
tube has been introduced, to see that it is patent, and that 
respiration is taking place freely. As a precaution, tape 
is usually threaded through the tube so that it will not 
slip down the larynx in any disorder which might ensue. 
Inasmuch as the outer tube comes into direct contact with 
the skin, it is a good plan to have a fine layer of gauze 
covered with boric ointment inserted between the tube and 
skin. 

Post-operative Treatment. —The tracheotomy tube is a new 
passage through which air is drawn into the lungs, and since 
the air is no longer brought through the normal channels, 
it is important that above all the tube should be kept 
patent and clean. In order to ensure perfect cleanliness 
and free respiration through the tube, nurses must be on 


TRACHEOTOMY 


duty day and night ever alert to see that the patient has 
plenty of air. The inner tube should be removed about two 
or three times a day, cleansed, sterilized, and gently rein¬ 
serted. It should never be cleaned in situ, i. e., as it rests 
in the patient’s trachea. If at any time the tube should 
become suddenly plugged, the inner tube must be withdrawn 
immediately. At times the patient is apt to cough, and the 
mucus which makes its appearance at the orifice of the tube 
should be wiped away very gently. Occasionally from 
coughing violently both the inner and outer tubes may be 
expelled, and for this reason it is always important to keep 
a tracheotomy dilator on hand to meet this important 


A 



Tracheotomy Tube. 

A, outer tube; B, inner removable tube; C, safety-guard; 
D, catch to hold inner tube in place; E, slot through which 
tape may be tied to hold safety guard in place. 

(From Colp & Keller’s Textbook of Surgical Nursing ) 

emergency. This instrument will keep this passage open 
until another tube may be obtained and inserted. 

Another important thing in these cases is to remember 
that the air which is now inspired no longer has the advan¬ 
tage of being warmed and freed from dust by the nasal 
passages. For this reason in the beginning, thin layers of 
gauze which have been wrung out in warm water should be 
placed over the tracheotomy orifice and changed every half 
hour. Some surgeons keep the patient under a croup tent 
so that the air may be warmed by the steam and the 
respiratory tract have the advantage of a warmed air. Com¬ 
pound tincture of benzoin may be added to the croup 
kettles. 

There are very few conditions which require more con¬ 
scientious nursing than do these patients, because their life 


TRANSFUSION 


is absolutely dependent upon the uninterrupted inflow and 
outflow of air through the tube. They should never be left 
alone, for one never knows at what moment the tube may 
become plugged and the patient become suddenly asphyxiated. 
Occasionally mucus may collect in the trachea and not be 
expelled through the tube. The reason for this is that the 
cough is insufficient in strength to expel the mucous plug. 
In these conditions a sterilized feather might be introduced 
through the tube and the trachea tickled, so as to incite 
coughing. The time for the permanent removal of the tube 
is purely at the discretion of the surgeon. Very often some 
surgeons will remove the double silver tube and replace it 
by a rubber one, then remove the rubber one when they 
see fit. 

TRANSFUSION 

A transfusion is the transfer of blood from one person 
(the donor) to another (the donee or recipient). It has 
proved of great value in the following conditions: 

1. Following a severe hemorrhage. 

2. In hemophilia and other conditions with lessened coagu¬ 
lability of the blood. 

3. In severe anemias (and leukemia). In secondary 
anemia it restores the volume of blood and tides over an 
emergency until the blood-forming organs can replace the 
loss. In pernicious anemia, an incurable disease, it gives 
temporary relief and prolongs life. 

4. In collapse or shock from any cause. 

5. In malnutrition or marked prostration. 

6. In septicemia, in severe toxemia from sepsis, gas 
poisoning (carbon monoxide, etc.), or acid intoxication. 
Some of the poisoned blood may first be withdrawn and 
replaced by the donor’s blood. 

7. Before an operation when the patient is in a very 
weakened condition. 

8. In patients suffering from malignant growths in order 
to increase their general resistance so as to guard agakist 
other diseases, such as pneumonia. 

Effects of the Treatment. —Its advantages over the saline 
infusion are said to be that, (1) It supplies nutritive material, 
oxyhemoglobin, and carbon dioxide, and tends to overcome 
acapnia (diminished carbon dioxide in the blood), in shock; 
(2) it does not transude so quickly from the blood-vessels, 
and is not so quickly excreted as saline, and therefore 
maintains the blood-pressure in hemorrhage longer and 
causes increased coagulability of the blood. 

There are certain difficulties and dangers encountered in a 
transfusion which necessitate the greatest caution, both in 


TRANSFUSION 


selecting and securing a donor, and in the method of collect¬ 
ing and transferring the blood. They are: 

1. The difficulty in securing a donor, also the expense 

involved. 

2. The danger of the blood clotting during the transfer. 

3. The danger of injury to the blood vessels. 

4. The danger of transferring diseases, such as syphilis. 

5. The danger from incompatibility of patient’s and 
donor’s blood. 

6. The possible collapse of the donor, and in some cases 
the veins of the recipient are small, collapsed, buried, and 
easily torn, making the treatment difficult. 

Before using the donor’s blood, to avoid the dangers of 
4 and 5 above, it is very carefully examined. The following 
tests are made: A red and white blood cell count, hemoglobin 
determination, a platelet count (platelets are concerned with 
the clotting of blood), a Wassermann test to exclude the 
possibility of conveying syphilis, a test for “grouping,” and 
a test for isohemolysins and iso-agglutinins. 

Method of Procedure. —During the withdrawal of blood 
the donor should be in the recumbent position, made 
thoroughly comfortable, and allowed to remain in this position 
for some time following the treatment. Any nervousness 
on his part should be dispelled. His color, pulse, blood- 
pressure and general condition should be carefully watched, 
and stimulants should be in readiness and used if necessary. 
An extra blanket, and ice water, etc., should be at hand. 
An increase in the respirations and pulse rate, yawning 
or deep sighing indicate that the withdrawal of blood should 
be discontinued. Pallor and sweating sometimes occur fol¬ 
lowed by collapse. 

For the withdrawal of blood the following articles are 
usually used: A rubber to protect the bed, sterile towels, a 
disinfectant for the skin, sterile cotton, sterile albolene (to 
coat the inside of needles, etc., to make the surface smooth 
and prevent clotting), needles, rubber tubing, a glass gradu¬ 
ate to receive the blood, sodium citrate solution, 3 per cent., 
a small glass graduate with which to measure the citrate 
(50 c.c. of citrate solution are used to 500 c.c. of blood), 
a basin of warm water in which to stand the flask to keep 
the blood warm, a glass rod, and a sterile dressing. 

The recipient must also be made quite comfortable and 
kept very quiet during the treatment. Restlessness and 
jerking of the arm make it very difficult to proceed, and 
may cause injury to the vein, displacement of the needle, 
hemorrhage, and loss of blood. The patient’s color and 
pulse should be noted before the injection. During the 
treatment it is very satisfying and fascinating to watch the 


TRICRESOLS 


color gradually appearing in the finger nails, and lips, etc., 
and to note the increasing strength of the pulse. 

The patient should be closely watched for symptoms of 
over dosage. An injection of too much blood may cause 
pulmonary edema and death. The symptoms of overdosage 
are distress about the heart, headache, backache, pains in the 
legs and a short, sharp cough. The latter symptom, particu¬ 
larly, indicates that only a limited amount of blood should be 
injected following it in order to avoid the danger of over¬ 
dosage. 

After Treatment. —After most transfusions there is apt to 
be a reaction manifested by chills and fever and sometimes 
nausea and vomiting. The nurse should always be prepared 
for this emergency. This may occur from ten to twenty 
minutes after the transfusion, and the treatment is the same 
as for any chill,—blankets, hot bottles and a little brandy, 
if permitted. It is advisable to save the urine of all these 
cases because it should be examined for the presence of 
altered blood. This will indicate whether the recently given 
blood has been of value to the patient, or whether it has 
been destroyed, and is being eliminated by the kidneys. 

TRICRESOLS 

See Cresols. 

TRIONAL 

Trional is a powder having a bitter taste. An average 
dose of trional usually produces natural sleep in about 
15 minutes to an hour after it is given. The sleep lasts 
several hours and is accompanied by slight headache. The 
effects of trional are the same as those of sulphonal. It 
is more readily absorbed, however, and it does not affect 
the heart or respiration as much. It occasionally causes 
the same cumulative poisonous symptoms as sulphonal. 
Trional should be given about a half to one hour before 
bedtime in large quantities of hot milk or beer. Dose, 
15 to 30 grains. 

See Sulphonal. 


TRITICUM 

Triticum is obtained from the Agropyron repens, or couch 
grass, a grass which grows in Europe and the United States. 

Triticum is said to increase the flow of urine. It is 
usually given in the form of a decoction; about 2 to 4 drams 
in a large tumbler full of water. 

Preparation 

Pluidextract of Triticum; dose 30 to 60 minims. 


TUBERCULOSIS 


TROPACOCAINE 

Tropacocaine is an alkaloid obtained from the leaves of 
the coca plant of Java. It is usually made artificially, how¬ 
ever. 

Tropacocaine is used principally to produce local anesthesia. 
Its effects are similar to those of cocaine, but they appear 
sooner, and last longer than those of cocaine. It does not 
dilate the pupil as much as cocaine. 

Preparation 

Tropacocaine Hydrochloride; dose % to i grain. 

This is used principally in 3 to 10 per cent, solutions. 

And see Cocaine. 

TUBERCULIN 

Old Tuberculin is a solution obtained by filtering a bouil¬ 
lon culture of living tubercle bacilli through a Berkefeld 
filter and adding a little glycerin tc it as a preservative. 
It contains the toxins of the tubercle bacilli. It is now 
only used to diagnose tuberculosis, either by injection, which 
causes a rise in temperature, or by the application to the 
skin. 

New Tuberculin is made by grinding up tubercle bacilli 
and mixing them with equal parts of water and glycerin. 

TUBERCULOSIS 

Human tuberculosis is an infectious disease like diphtheria, 
or typhoid fever, due to similar germs spread in exactly the 
same ways, having similar stages, and controllable by like 
methods. But it is long drawn out; it is chronic rather 
than acute; it is mild and slow, not severe and rapid. 

Carriers in the true sense are not widely recognized, and 
immunity, although demonstrated, is slow in development 
and perhaps slight in degree. No specific treatment is known, 
although tuberculin seems to help in some forms. 

The treatment of tuberculosis is the treatment of all 
infectious diseases for which we have no specific antitoxin 
or other specific agent, i. e., the treatment is the same as 
for scarlet fever or for mumps—rest in bed, proper nourish¬ 
ment, fresh air, and care of incidental infections, with the 
hope that these measures will keep the patient from dying 
long enough for the patient to make his own antidotal bodies, 
or at least develop sufficient fibrous tissues about the lesions 
to limit further growth. Corresponding to the long drawn- 
out character of the disease, these factors in treatment take 
on peculiar emphasis and interrelate even more importantly 
than in the acuter diseases; but they are nevertheless the 
same factors. 


TUBERCULOSIS 


Under the term tuberculosis two separate diseases exist 
in the human, one derived almost exclusively from cattle, 
through drinking raw cow’s milk; the other almost exclu¬ 
sively from human cases, through the mouth discharges of 
infectious stages of the pulmonary disease. The former 
affects chiefly children and is almost unknown after sixteen 
years of age; the latter affects chiefly adults, and, as an 
infectious stage of the pulmonary disease, is almost unknown 
before sixteen years of age. 

See Infectious Diseases, Course of. 

TUBERCULOSIS, NURSING CARE IN 

The modern conception of tuberculosis brings new duties 
and responsibilities to every nurse. The fact is now 
thoroughly established that at least 90 per cent, of all adults 
who live a highly organized community life have been 
infected by the tubercle bacillus, and that two-thirds of all 
the children have acquired a first infection by the time 
they are fifteen years of age. Surveys and studies made 
in different parts of the United States at different times 
have indicated that about 1 per cent, of the population 
is suffering from active tuberculosis all the time, which 
means about 1,000,000 people in the whole country; 120,000 
of these patients died in 1920. Do not these facts furnish 
an imperative reason why every nurse should be thoroughly 
informed in regard to the symptoms and nursing care of 
this preventable disease? It is now generally believed by 
the best authorities that an infection once established may 
persist for years through many recurrent periods of activity 
and quiescence, dependent upon circumstances in the life 
of the individual, and that it is finally some adverse condi¬ 
tion which leads to the development of manifest tuberculosis 
in the lungs. 

Some knowledge about the conditions favoring such break¬ 
down is necessary in order to intelligently carry out the 
methods of treatment necessary for recovery and to educate 
the patient in regard to the living habits which he must 
maintain to prevent a recurrence of active disease. 

Conditions favoring development of active disease:— 

Other diseases (pneumonia, pleurisy, measles, whooping 
cough, influenza, etc.); mental and physical stress and strain; 
pregnancy, parturition, and lactation; malnutrition; unsani¬ 
tary living or working conditions; dissipation; injury. 

Symptoms of active disease:— 

Lassitude; weakness; cough or hoarseness extending over 
a number of weeks; expectoration; elevation of temperature 
in afternoon or evening; increase in or irregularities of the 


TUBERCULOSIS 


pulse rate; digestive disturbances; nervous instability; 
dyspnea; pain in the chest; underweight or loss of weight; 
loss of appetite; night sweats; slow recovery from other 
diseases; hemoptysis. 

Frequent Complications: — 

Tuberculosis of the larynx and intestines; hemorrhage; 
pleural effusion; spontaneous pneumothorax. 

Precautions against the spread of infection:— 

Tuberculosis is classed with the communicable diseases, 
but differs in many respects from most of the others with 
which we are familiar. The tubercle bacillus, the infective 
agent, may attack any tissue in the body and thus we have 
many different types of the disease, which may be classified 
as to point of attack and according to age as follows: In 
infants, generalized, disseminated, acute; in children, bones, 
joints, lymph nodes, meninges; in adults, chiefly the lungs, 
but also the skin, kidneys, intestines and any other tissue. 

The most dangerous type from the point of view of 
infection is pulmonary tuberculosis. Many patients, how¬ 
ever, with a considerable degree of active disease in the 
lungs raise no sputum; and frequently, when sputum is 
present, repeated laboratory examinations fail to disclose 
the bacillus. On the other hand many people with no 
apparent active disease may be “carriers” and therefore 
sources of danger. The only safe procedure is to practise 
the same rigid sputum technique with every patient having 
pulmonary disease. All secretion from the lungs, nose or 
mouth must be considered as potentially dangerous. The 
patient should be taught never to cough or sneeze without 
covering the mouth and nose. For this purpose paper hand¬ 
kerchiefs are much to be preferred and each one should 
be used only once. Old pieces of cloth may be used in the 
same way. Where the sputum is scanty these pieces of 
cloth may be cut into small pieces, but a sufficient quantity 
of cloth should be used to absorb all the moisture without 
soiling the fingers. After using, the handkerchief should 
be placed by the patient in a paper bag (oiled or waxed 
bags can be procured for this purpose) or in a pocket 
folded from a newspaper and pinned to the mattress within 
easy reach. The bag with its contents should be collected 
and burned at regular intervals. Ambulant patients may carry 
the paper bag in a pocket, folding the handkerchief together 
carefully after using so as not to soil the edges of the 
pocket. When a patient raises a large amount of sputum, 
a folded paper sputum cup in a metal frame or holder with 
a cover may be necessary. Constant vigilance will be 
required to see that the edges and sides of the cup or 
container do not become soiled with the sputum which 


TUBEBCULOSIS 


may subsequently dry and release tne bacilli to be scattered 
in the dust and air. The menace of flies in this connection 
must also be considered. 

A point always to be remembered is that liquid sputum will 
not burn and it is absolutely necessary that it should be 
mixed with some absorbent material (sawdust, heavy ab¬ 
sorbent paper, etc.) before being consigned to the fire. If it 
should be impossible to burn the sputum it should be 
thoroughly disinfected before being disposed of in any 
other way. Carbolic acid in 5 per cent, solution is usually 
preferred for this purpose. Bichloride of mercury should 
not be used, as it hardens the albuminous material in the 
sputum and therefore may not be able to penetrate the 
mass. Lysol or other standard coal-tar disinfectants may 
be used. In the care of the patient’s room, bed and body 
linen, dishes, etc., the ordinary routine for all infectious 
diseases should be carried out. 

Nursing Care. —The fundamental factors in the treatment 
of tuberculosis in order of their importance are (a) rest, 
( b ) food, (c) fresh air, (d) discipline and strict regimen 
under medical supervision. This treatment usually means 
almost a complete reversal in the mental and physical 
habits of the patient, and the result depends to a very 
great degree upon the attitude of min'd which will govern 
his actions. “The will to be well” which keeps a patient 
faithfully following day after day the regimen prescribed by 
his physician will often be the determining factor in his 
recovery. The responsibility of impressing this fact with 
the necessary emphasis upon the consciousness of the patient 
rests first with the physician, and second with the nurse. 
The measure of success attained by the nurse will depend 
largely upon her knowledge and understanding of the 
principles and practice involved, her interest in studying 
the personality of the different patients, and her ability to 
translate her knowledge in such a way as to secure the 
earnest cooperation of each patient. 

Best. —The word rest as applied to the tuberculosis patient 
is a very definite term; and the nurse in charge is respon¬ 
sible for ascertaining its limits, and seeing that they are 
not exceeded. The hours to be spent in bed or chair should 
be prescribed by the physician; and the nurse must see that 
these orders are as strictly carried out as are those for the 
giving of medicine. Since the bed or chair should be in 
the open air, the chief problems for the nurse are those of 
making the patient comfortable—in winter protection from 
wind and cold, in summer from sun, wind, dust and insects. 

Protection from cold.—For protection from cold remember 
that the object of clothing is to prevent the escape of 


TUBERCULOSIS 


bodily heat into the surrounding air. In bed the patient 
should be as carefully protected from underneath as from 
above. Two mattresses, folded blankets, or a comfort on 
top of the mattress, and heavy sheets of paper under the 
mattress, are all effective for this purpose. Care should be 
taken that the upper covers are not so heavy as to tire 
the patient with their weight. The patient should have an 
extra suit of underwear for the night and the sheets should 
be made of outing flannel, or light weight cotton blankets 
may be used. A blanket, one end of which is placed cross¬ 
wise under the mattress, and the other end brought up over 
the bed after the patient is installed therein, and tucked 
securely in on the opposite side will prevent the covers 
from being loosened and the heat within from escaping. 
A blanket folded loosely lengthwise and placed in the bed 
on each side of the patient will often prove the best 
method for protecting those who are apt to feel chilly 
towards morning. Hot water bottles and jugs, electric pads, 
etc., may be used, if necessary, to keep the patient com¬ 
fortable, but it is better to do without them whenever other 
means can be devised. The head should be protected by a 
cap or hood which will fit closely to the face. 

Sitting out of doors. —When sitting out of doors, the 
type of chair is of first importance. It should have a firm 
back so that no rounding of the shoulders will be induced, 
and it should give support to every part of the body 
including the feet. 

Food. —To plan an adequate diet for a tuberculous patient 
it is necessary to understand thoroughly the factors involved, 
which are: (a) the objects to be attained; and, ( b ) the 
foods which will supply the elements needed to secure the 
desired result. The chief object is to build up and main¬ 
tain the weight of the patient at about ten to fifteen pounds 
above his normal weight before he began to be affected 
by the disease. Care must be exercised continually that 
the digestion of the patient is not upset and his appetite 
diminished by over feeding or monotony in the diet. This 
requires a knowledge of food values, the relative require¬ 
ments as to proteins, fats and carbohydrates, and careful 
observation and study of the tastes and idiosyncrasies of the 
individual patient. A slow, steady gain in weight with a 
corresponding increase in strength is a better indication of 
an adequate diet than a rapid fattening process without 
other signs of improvement. Three good meals a day, with 
a mixed diet, which includes such a quantity of milk as 
the patient can take without affecting his appetite for the 
other articles on the menu, will give the best results in the 
majority of cases. Faithful adherence to the directions for 


TUBERCULOSIS 


rest in the open air will be a great factor in maintaining 
good digestion and appetite. 

In certain complications such as tuberculosis of the 
larynx, intestines, hemorrhage, etc., special diets are required. 
These should be prescribed by the physician. 

Fresh Air.—For patients who cannot for any reason 
“take the cure” in a sanatorium, home arrangements should 
approximate sanatorium conditions as nearly as possible. If 
a porch is not available, the bed patient should have as large 
a room as possible, where cross ventilation may be secured 
and where the windows are so located that the sun may 

shine in for at least a portion of the day. The bed should 
be so placed that while protected from severe draughts, a 
constant circulation of air goes on around the patient’s 
head and shoulders. The patient must be so clothed as to 
be perfectly comfortable, and the windows should not be 
closed, except for short intervals when absolutely neces¬ 
sary, even in time of rain or snow. The results of this 
treatment as manifested usually in relief of cough, disap¬ 

pearance of night sweats, increase of appetite, improvement 
of digestion, relief of insomnia and lowering of fever, soon 
bring to the patient such a sense of improvement that he 
will sometimes protest against even a temporary closing of 
the windows. 

Discipline and strict regimen. —There is probably no other 
lisease where careful and persistent attention to the small 
details of treatment have so great a bearing on results. 
Dr. Lawrason Brown of Saranac Lake says, “To get well 

from tuberculosis means that a patient must pay attention 

to every little detail. He must watch and make no mistakes, 
for these often prove fatal.” Hence it is the duty of every 
nurse who assumes the care of such patients to make herself 
thoroughly familiar with every detail concerned with the 
treatment of tuberculosis by study of some good modern 
text book on the subject, and by reading such articles as 
are published from time to time in the medical and nursing 
journals. Further information may be obtained by writing 
to the National Tuberculosis Association, 370 Seventh 
Avenue, New York City. 

Cough.—The patient must be taught to control his cough 
in large measure (a) by avoiding exciting causes so far as 
possible such as loud talking, laughing, etc., and ( b ) by 
adopting various simple devices which experience has shown 
to be effective, e. g., sips of cold water, slow full breaths, 
holding the breath, etc. For morning cough when severe, 
a glass of hot water with lemon juice, or a cup of hot milk 
or other hot drink before the patient gets out of bed 
may help. Cold packs on the throat are sometimes ef- 


TUBERCULOSIS 


fective. Drugs should only be given as prescribed by the 
physician. 

Nightsweats.—Nightsweats in tuberculosis are usually a 

sign of weakness or of lack of sufficient ventilation. Sleep¬ 
ing in the open air is the best preventive treatment. Change 
the position of the patient’s bed, if within a room, so that 
a greater current of air may flow around it. Friction of 
the skin with tepid vinegar or alcohol and water may 
prove effective. 

Hemorrhage. —Every nurse caring for a tuberculous patient 
should get from the physician in charge detailed standing 
orders for procedure in case of hemorrhage, as individual 
physicians prefer different methods. This emergency usually 
occurs without warning and calls for immediate action. The 
chief indications for treatment are to secure as nearly as 
possible absolute rest of the part affected, to reduce the blood 
pressure, and to increase the coagulability of the blood. The 
first duty of the nurse is to reassure the patient, who is apt 
to be frightened, and to begin at once the treatment pre¬ 
scribed. The patient is usually put into a semi-sitting 
position, and the nurse should in every way possible help 
the patient to maintain a perfectly tranquil, relaxed attitude. 
There are various drugs which may be employed to advan¬ 
tage, but they should be used by the nurse only with the 
direction of a physician. 

Pleurisy. — Symptoms :—pain in the chest; dyspnea; cough. 

Treatment :—external applications to produce counter irri¬ 
tation may give relief from pain. Salicylates or aspirin 
are often given. In cases where the pain is very severe it 
may be necessary to strap the chest with adhesive plaster. 
The patient should be kept in bed. 

Spontaneous Pneumothorax. — Symptoms :—The attack 
comes on very suddenly, usually after some exertion, par¬ 
ticularly a severe paroxysm of coughing. On taking breath, 
the patient feels a sharp pain in his side, and rapidly 
develops extreme difficulty in breathing, followed by the 
characteristic symptoms of shock (rapid, feeble pulse; cold, 
clammy extremities; drawn look in the face, etc.). The 
respirations are rapid and shallow, and the temperature 
drops to subnormal. In severe cases the patient may live only 
a few hours; but in the majority of cases the circulation 
gradually becomes adjusted to the changed conditions; the 
dyspnea is relieved though the respiration remains con¬ 
siderably increased for some time; and the temperature 
rises to above normal. 

Treatment :—A hypodermic injection of morphine is 
usually prescribed to control the pain and the usual measures 
to counteract shock are employed, namely, heart stimulants 


TURBINATES, HYPERTROPHY OF 

and external heat. If the pain is not relieved by the 
morphine and the case is seen to be desperate, the physician 
sometimes punctures the thorax with a hypodermic needle 
to allow the escape of air. 

Conclusion. —The preceding paragraphs have dealt almost 
exclusively with the physical aspects of the sick, tuberculous 
patient. The service and the responsibility of the nurse 
should not in any sense be limited to this one phase of 
the tuberculosis problem. To bring about the arrest of 
active disease in a patient is not enough, as experience has 
clearly shown. The “cure” cannot be pronounced perma¬ 
nent until the patient is returned to active productive life 
among his peers. This fact must be kept in mind from 
the very day the treatment begins and its whole course must 
be shaped accordingly. To the purely medical treatment 
must be added thorough education in the hygiene of pre¬ 
vention (both in regard to the spread of infection and the 
recurrence of active disease), and such intellectual and 
vocational training as is indicated in each individual case. 

The nurse should play a very large part in this rehabili¬ 
tation program, as the morale of the patient is influenced very 
greatly by the inspiration and encouragement (or lack of 
these) which she can give him. 

TURBINATES, HYPERTROPHY OF 

See Nose. 

TURPENTINE (TEREBINTHINA) 

There are two kinds of turpentine: turpentine or White 
turpentine, and Canada turpentine or Canada balsam. 

Turpentine, or white turpentine, terebinthina, is a thick 
resinous substance, or solid oleoresin obtained from the 
sap of the Pinus palustris, and other species of pine trees. 

Canada turpentine, terebinthina canadensis, or Canada 
balsam, or balsam of fir, is a liquid oleoresin obtained from 
the Abies balsamea, the American silver fir, or balm of 
Gilead tree, which grows in the northern parts of the United 
States. This form of turpentine is seldom used. The tur¬ 
pentines contain a volatile oil, oil of turpentine, or spirit of 
turpentine, which causes their effects. 

Xiocal action: Turpentine or the spirit of turpentine, red¬ 
dens the skin. If it is kept on the skin for any length of 
time, it causes blisters. 

Internal Action: When taken internally, the oil of tur¬ 
pentine produces the following effects. 

In the stomach: It checks the formation, and hastens the 
expulsion of gas. Part of it is absorbed into the blood from 
the stomach. 


TURPENTINE 


In the intestines: It acts as an antiseptic, checking the 
growth of bacteria. It expels gas and increases peristalsis. 
It is said to expel worms. 

On the kidneys: Turpentine and the oil of turpentine 
increase the flow of urine. This effect is produced by the 
turpentine after it is absorbed into the blood. 

Turpentine is said to make the pulse somewhat stronger 
and faster. 

Excretion 

Turpentine is eliminated from the body by the lungs, 
where it increases the cough and expectoration, and acts 
as an antiseptic. It is also excreted by the kidneys and 
gives the urine a violet color. 

Poisonous Effects 

Overdoses of turpentine cause: 

1. Unconsciousness. 

2. Scanty, often bloody urine. 

3. Rapid, feeble pulse. 

4. Occasionally vomiting, and diarrhea, with painful stools. 

Uses 

Turpentine is applied to the skin to relieve pain and to 
withdraw blood from the deeper tissues; occasionally to form 
a blister. 

To increase the flow of urine. 

To expel gas from the intestines. 

To increase the cough and expectoration, and to check 
the growth of bacteria in the lungs. 

Turpentine destroys tape worms and round worms. 
It is given in doses of one ounce with twice its amount of 
castor oil. It is also given in very small doses, together 
with other anthelmintics. It is very apt to cause poisonous 
symptoms and is therefore not frequently used. 

Administration 

For its effects on the skin, turpentine liniments are used, 
or the drug is applied in the form of a “stupe.” (See 
Fomentations.) 

Internally, turpentine is best given in capsules or in an 
emulsion. As an expectorant, it is frequently given by 
inhalations. 

Turpentine is also often added to enemas to help the 
expulsion of gas. 

Preparations 

Oil of Turpentine; dose 5 to 15 minims. 

This is obtained by distilling turpentine. 


TURPETH MINERAL 


Purified Oil of Turpentine; dose 5 to 15 minims. 

Emulsion of Turpentine Oil; dose 1 dram. 

Turpentine Liniment. 

TURPETH MINERAL 

See Emetics. 

TWILIGHT SLEEP 

See Scopolamine-Morphine Anesthesia. 

TYMPANITES (POST-OPERATIVE) 

The distention of an abdomen following operation is due 
to a gastric dilatation, a distention of the small or large intes¬ 
tine, or a dilatation of the bladder resulting from urinary 
retention. The word tympanites or meteorism denotes an 
inflation of the abdomen with gas. This gas is usually 
intestinal; occasionally it may be free in the peritoneal 
cavity from a perforation of the intestines. A condition of 
gastric dilatation is recognized by distention in the upper 
abdomen; that of the small or large intestine, by a generalized 
abdominal distention; that of the bladder by palpation of a 
rounded mass just above the pubes and the failure of the 
patient to void urine after operation. Tympanites is certainly 
distressing and modern surgical nursing commands many 
methods to alleviate and relieve this condition, bringing 
much comfort to the patient. 

Treatment. —The theory underlying all treatments is to aid 
the patient in ridding the small intestines and colon of gas. 
The means for accomplishing this are many. One of the 
simplest procedures and one of the most efficient is the 
introduction of a rectal tube. 

A rectal tube is a small piece of rubber tubing about 
three-eighths of an inch in diameter, rounded at one extrem¬ 
ity. This is well lubricated with either K-Y or vaseline, and 
gently introduced into the rectum beyond the internal and 
external sphincters, and about three to four inches beyond 
the anus. The purpose is to form an exit for gas which may 
have accumulated in the colon. This simple procedure is 
often all that is necessary. Other procedures are purgative 
enemas and colonic irrigation. (See Enemas and Colon 
Irrigations.) 

TYPHOID OR ENTERIC FEVER 

Typhoid fever is an acute, general, specific, infectious, com¬ 
municable disease with local lesions in the intestines. 

Nursing Care and Treatment. —Dr. Osier has said that 
“careful nursing and a regulated diet are the essentials in 
a majority of cases,” and that the disease can only be 


TYPHOID FEVER 


modified by placing the patient in the best possible mental 
and physical condition to withstand the invasion of the 
bacteria and their toxins. It is a disease in which attention 
to the little details is most important and brings the best 
results. 

“That sufficient physical and mental rest and sleep are 
obtained, if possible,” is the first important factor. “Real 
rest can be obtained only by careful and competent nursing.” 

Rest means not only rest in bed, but in a comfortable bed, 
free from all sources of discomfort. The position must be 
comfortable, never strained, to avoid pain or other dis¬ 
comfort. The patient should never be allowed to sit up. 
The position should be changed frequently, but the patient 
should not be allowed to move himself. All exertion must 
be avoided in making the bed, giving a bath or other treat¬ 
ments, using the bedpan, and in feeding him, etc. Every 
movement is a waste of energy so everything should be 
done for him. Mental rest—freedom from cares, anxiety, 
excitement and all mental demands, all of which cause 
fatigue—is essential. Nervousness and excitement during 
treatments, or due to forced diet, etc*, must be avoided. No 
visitors should be allowed; the mental effort of listening to 
or keeping up a conversation causes an elevated tempera¬ 
ture, a rapid pulse, restlessness, and wakefulness. Cold 
baths usually relieve nervousness, excitement and wakeful¬ 
ness; sometimes chloral, bromides or opium is necessary. 

The room (in a private home) should have, as far as 
possible, all the characteristics of the hospital ward—large, 
well ventilated, proper lighting, free from unnecessary fur¬ 
nishings, quiet, systematic, orderly, no visitors and with 
proper facilities for the disposal of discharges, etc., and 
the care of linen. The bed must be clean, comfortable, dry, 
free from wrinkles, crumbs or any other source of discom¬ 
fort or cause of bedsores. It must be well protected as the 
patient is apt to have involuntary movements. It must not 
be too warm and the clothes, particularly over the toes, must 
not be too tight. 

The Patient .—He should have a daily cleansing bath and 
everything about him should be kept sweet and clean. His 
hands should be washed several times a day. A delirious 
patient is apt to contaminate his hands with fecal material 
and reinfect himself. The position must be the constant 
recumbent, but should be changed frequently to avoid pneu¬ 
monia and pressure sores. 

Bedsores .—The marked emaciation, the destructive effect 
of the fever and toxins, the impaired metabolism, poor circu¬ 
lation, low blood-pressure (shown by the patient’s dusky 
hue), the prolonged illness, and the profound involvement 


TYPHOID FEVER 


of nerve centers make even slight pressure a source of 
great danger. The patient may lose control over the bladder 
and rectum and this adds to the danger. The proper care 
of the skin, the cold sponge and cold tub-baths by stimulat¬ 
ing the circulation and the functions of the skin aid greatly 
in preventing bedsores. 

The care of the mouth and nose is extremely important. 
A neglected mouth may cause infection of the ears, tonsils, 
lungs, parotid glands, erysipelas, and the patient may 
reinfect himself with typhoid. It makes the patient uncom¬ 
fortable, has a depressing mental effect, destroys the appetite, 
upsets the stomach and digestion. 

The mouth must be kept clean and moist. It should be 
cleansed morning and evening and after each feeding. Care 
must be taken not to cause the patient to gag, also to avoid 
injury to the delicate mucous membrane. Cold cream should 
be applied to the lips and tongue half an hour before cleans¬ 
ing to soften a tender or badly coated tongue. Plenty of 
water to drink aids greatly in keeping the mouth in good 
condition. Bits of cracked ice to suck relieve the dryness 
and thirst. 

Headache is a common and most distressing symptom. It 
should be relieved by the application of an ice-cap or ice 
compresses to the head. 

Backache and Aching Limbs. —The spine is frequently 
very tender and pains in the back and limbs may cause great 
suffering. Pillows should be arranged so as to support the 
back and keep the tender spine entirely free from the bed. 

Sleeplessness is the most exhausting symptom. It is 
relieved by hydrotherapy, chloral, bromides, or morphine, 
etc. 

Thirst is a constant source of discomfort. Even though 
the patient be too dull to ask for it, water should be given 
freely. One of the principles of treatment is to give water 
regularly and freely. 

Cold hands and feet, resulting from the low blood-pressure 
and poor circulation, are often a source of discomfort. A 
hot-water bottle should be applied. 

Retention of urine often occurs and should be looked for. 
The bladder must be emptied by nursing measures used to 
relieve retention or by catheterization. 

Abdominal pain, tenderness, and distention are distressing 
symptoms which must be particularly guarded against. Dis¬ 
tention may develop into the dreaded tympanites—dreaded 
because it predisposes to perforation and peritonitis and 
once developed is difficult or impossible to reduce. It is 
prevented by carefully regulating the diet, by giving plenty of 
water and preventing the accumulation of fermentation sub- 


TYPHOID FEVER 


stances in the intestines by keeping the bowels open. Fre¬ 
quently a daily cleansing enema is given. The cold baths 
also help to prevent distention by improving the muscular 
tone of the intestines. Turning the patient also helps to 
prevent the accumulation of gas. 

Maintaining Vital Resistance by Proper Feeding is the 
third important factor. The diet is an extremely difficult 
problem and doctors differ widely in what they consider 
safe for the patient. Some believe in a very low diet, almost 
starving the patient. Others believe in giving a high caloric 
diet —“as much food as the patient will take and handle 
well.” This varies with the patient, depending upon the 
appetite, gastro-intestinal disturbances, and toxemia. The 
high caloric diet is regulated by the following principles 
(Coleman) : 

1. That the minimum daily caloric requirement is 41 
calories per kilo. 

2. That the optimum daily caloric allowance is 60 to 80 
or more calories per kilo, the average for a man weighing 
150 pounds being 4000 calories. 

3. That the minimum amount of protein should be given, 
sufficient to meet the body needs without taxing the tissues, 
the kidneys and other organs of elimination. 

4. That fats should be given with care on account of the 
difficulty in digesting them and their tendency to cause 
diarrhea and other gastric disturbances. 

5. That carbohydrates are the most efficient energy pro¬ 
ducers and are the great protein sparers. 

The optimum daily protein allowance is 75 to xoo gm. 

The daily carbohydrate allowance is 250 to 800 gm. 

The daily fat allowance is 50 to 200 gm. 

The basal diet consists of milk, cream, eggs (raw, soft- 
boiled, or soft-poached), milk-sugar, stale bread, or toast and 
butter. Milk substitutes and milk preparations are used— 
buttermilk, kumyss, cocoa, whey, junket, custard and ice 
cream, etc.; strained gruels, boiled rice or macaroni, baked 
potato, apple sauce and liquids, such as lemonade, orange¬ 
ade, tea and meat broths, etc., are also included in a high 
caloric diet. 

Whatever feeding is ordered by the doctor for the patient, 
the following principles must be observed by the nurse: All 
feedings must be given regularly and at stated intervals. 
The patient must never be forced but should be encouraged to 
take all the food allowed, the nurse remembering the im¬ 
portance of the diet in the patient’s recovery. The fancies 
of the patient must be considered as far as possible; avoid 
things disliked, because they spoil the appetite and turn the 
patient against all nourishment. Note whether foods dis- 


TYPHOID FEVER 


agree or not; watch for a coated tongue, nausea, a sense 
of fullness, distention or diarrhea, and examine the stools 
for curds of milk and for undigested fat. Milk diluted 
with lime water or vichy is more easily digested—adding a 
pinch of salt also makes it more palatable and more easily 
digested. Give sweet milk very slowly, a teaspoonful at a 
time to prevent the formation of solid curds. When sweet 
milk is not taken well, buttermilk may be given. It is more 
easily digested, causes less nausea, distention, and diarrhea, 
because the fat is removed and the casein is finely divided 
owing to the lactic acid present and the mechanical action 
used in removing the cream or fat. Milk sugar is used 
instead of cane sugar because less sweet (sweet things are 
always nauseating to sick people), and because it ferments 
less easily. With many, however, it causes nausea, vomiting 
and distention; watch for this effect. Cold weak tea will 
often settle an irritated stomach. Meat broths have no 
caloric value and should not be considered as nourish¬ 
ment given, but they are tasty and improve the appetite. 
See that they are properly seasoned and varied as far as 
possible. They must not be given if diarrhea is present. 

Lemonade, orangeade and imperial drink are grateful and 
refreshing to the patient. They are a means of sup¬ 
plying water and sugar to the tissues; they help to keep 
the mouth in good condition and have both a laxative 

and diuretic effect. Water should be given at regular 

intervals whether the patient seems to be thirsty or not. 
Two or three quarts and more, if possible, should be given 
daily. 

When feeding the patient all exertion must be avoided. 
A glass drinking tube may be used, but if the patient is 
delirious or in a stuporous condition, he should be fed with 
a teaspoon. As a rule, patients are not awakened at night 
from a natural sleep for nourishment, but a dull, stuporous 
condition must never interfere with the regularity of the 

feedings. 

Alcohol is used, by some doctors, in some cases. 

‘‘The Elimination of Effete Materials by the Kidneys, 
Bowels and Skin .”—Every avenue of escape must be kept 
open for the elimination of toxins and other waste products. 

The skin is kept in good condition and elimination stimu¬ 
lated by giving plenty of water to drink, by cleansing baths, 
by cold sponge or tub baths, by alcohol rubs and massage 
and by general improvement of the circulation. 

The kidneys are stimulated and flushed, the toxins are 
diluted and eliminated by giving large amounts of water, 
lemonade and imperial drink, etc. The kidneys are rested 
by giving a minimum protein diet and aiding elimination by 


TYPHOID FEVER 


the skin and intestines. Cold sponge and tub baths stimu¬ 
late the kidneys and aid elimination. 

Typhoid bacilli may be eliminated in large numbers in 
the urine, particularly if there is any interference with the 
proper flushing of the kidneys and in retention of urine. 
Urotropin is given as a urinary antiseptic. When retention 
of urine must be relieved by catheterization, extreme care 
must be taken to avoid infection, as the weakened bladder 
and lowered resistance make it very susceptible to infection 
by pathogenic organisms. 

Proper elimination from the bowels is extremely impor¬ 
tant. The intestine is the seat of the local lesions. The 
patient should be watched for symptoms of distention and 
the stools watched for the presence of flatus, undigested 
food and blood. A daily cleansing enema is frequently 
given—care must be taken to avoid force or pressure and 
exertion or straining on the part of the patient. The 
enema should be small and not high. Great care must be 
taken in the use of the bedpan, also to avoid exertion. 
When lying down, the elevation of the hips on the bedpan 
always causes some strain and difficulty in movement, so 
that in some cases (when hemorrhage and perforation are 
particularly feared), even this slight exertion is not allowed. 
A large pad is used in place of the bedpan. The recumbent 
position is always maintained unless otherwise ordered. If 
tympanites develops it is treated by the insertion of a 
rectal tube, carminative enemata, the application of tur¬ 
pentine stupes to the abdomen and careful regulation of 
the diet. 

The Relief of Toxemia. —Toxemia may be very severe, 
particularly in the second and third week, and may cause 
death. It is relieved by carefully regulating the diet, keep¬ 
ing up the resistance, giving plenty of water, aiding the 
elimination and by the use of cold air and cold tub or sponge 
baths. For the effect of the cold baths see Brand Bath. 

Complications to be Guarded Against. —Typhoid fever is 
not feared so much for itself as for the complications 
which are apt to develop. Without complications the fever 
runs its course and the patient usually gets well. It is, 
therefore, important to know how to guard against such 
complications, to recognize their symptoms, and to know 
what to do should they develop. It is important to remem¬ 
ber that the height of the fever and the severity of the 
attack have nothing to do with the danger of complications, 
as they are just as likely to occur with a light attack. Good 
nursing does, however, help in lessening the danger of 
complications. 

The complications which may develop are a recrudescence 


TYPHOID PEVER 


or relapse, hemorrhage, perforation, cholecystitis, meningitis, 
phlebitis, thrombosis, pulmonary embolism, pneumonia, paro¬ 
titis, otitis media, mastitis, bone lesions and arthritis. 

The end of the second and during the third week is the 
most dangerous period, owing to the patient’s weakened 
condition and lowered resistance. Necrosis, sloughing and 
ulceration of the intestinal lesions occur so that hemorrhage 
and perforation are particularly to be feared during this 
period. A sudden rise or fall in the temperature, or a sud¬ 
den change in the pulse rate usually indicates complications. 
Chills may precede pleurisy, pneumonia, otitis media or 
parotitis, etc. Severe headache may indicate meningitis. 
The prognosis in hemorrhage or perforation is always very 
grave. 

A hemorrhage usually comes without any warning. The 
symptoms are a sudden fall in the temperature, sometimes a 
sensation of sinking and at the same time or later, the 
appearance of blood in the stools. There may be pallor, 
cold extremities, clammy sweat, a rapid, thready pulse, rest¬ 
lessness and air-hunger. The treatment is to stop all food, 
keep the patient at absolute rest, moving him only when 

absolutely necessary, an ice-coil to the abdomen, and the 
administration of calcium lactate or an injection of horse 
serum or human serum to aid the clotting of blood. Mor¬ 
phine may be given to insure absolute rest of the patient 
and of the intestines. No bowel movements are allowed 
for two or three days and then with caution. When the 
loss of blood is so severe as to deprive the vital centers 

and the heart, it should be treated like any other hemor¬ 
rhage by elevation of the foot of the bed, heat to the ex¬ 
tremities and transfusion, etc. 

Perforation is even more dangerous than hemorrhage. 
The only hope for the patient is in its early recognition and 
immediate operation to close the perforation. It is due 

to ulceration or to distention with rupture of the weakened 
wall. It is most apt to occur in the third or fourth week. 
The symptoms are a sudden, sharp abdominal pain, a rapid 
rise in leucocytosis followed by the symptoms of general 
peritonitis—a rapid, thready pulse, rapid, shallow respira¬ 

tions, the temperature may fall, then rises, pallor, a pinched, 
anxious expression, cold, clammy sweat, persistent vomiting, 
local tenderness and rigidity. 

The symptoms and treatment of other complications are 
the same as when the diseases occur alone. 

Precautions to Prevent the Spread of the Disease. —The 
nurse should wear a gown and cap. Rubber gloves may be 
worn, if not the nurse should carefully scrub and disinfect 
her hands after each treatment. When giving a tub bath 


TYPHOID FEVER 


a rubber apron should be worn. After waiting on the pa< 
tient the nurse should avoid touching anything with her 
hands before disinfecting them, and should be particularly 
careful before going to meals and should avoid touching her 
face with her hands. 

The patient should be covered with screens to protect 
from flies, both for his comfort and to prevent the flies 
from spreading the infection. 

All the utensils to be used for the patient—dishes, tray, 
cutlery, bath tub, thermometer, bedpan, urinal, rectal tubes, 
etc.—should be carefully marked and isolated. They should 
be disinfected after use. 

All the bedlinen and goums, etc., used for the patient 
must be disinfected. 

All discharges from the patient, the urine, stools, sputum, 
vomitus and bath water—must be disinfected. When the 
patient has involuntary movements, the nurse should be 
particularly careful in caring for the patient and in the dis¬ 
posal of the stool and linen, etc. Oakum pads are usually 
used under the patient. The nurse should wear rubber gloves 
throughout the procedure and in washing the linen even 
after it has been disinfected. The oakum pad with the 
stool should be securely wrapped in paper so that even 
rough handling in the garbage or sewage disposal will not 
scatter the stool and spread the infection. 

After the disease is over the bed, mattress, blankets, linen 
and utensils, etc., should all be thoroughly disinfected. 

Care of the Patient during Convalescence. —Convalescence 
usually begins in the fourth week, but the danger of heart 
failure and other complications must be constantly remem¬ 
bered. A recrudescence or relapse may occur in the fifth or 
sixth week. The diet is carefully regulated, eliminations 
promoted, and the pulse and temperature are carefully 
watched. All physical exertion and mental excitement are 
avoided until the temperature has been normal for at least 
a week. The same care regarding visitors, reading and 
conversation, etc., should be observed as during the disease. 
When the patient is finally allowed up he should be advised 
to move about slowly and avoid fatigue or mental excite¬ 
ment. Fresh air and sunlight are very important. 

See Brand Bath; Infectious Diseases, Course of. 

Prophylactic Treatment.—Wonderfully good results have 
been obtained from the injection of killed bacilli as a pro¬ 
phylactic measure against typhoid fever both in military and 
civil life. Statistics show a steady decline of typhoid in the 
U. S. Army since the introduction of compulsory vaccina¬ 
tion in 1910. Only one case occurred in 1913 among over 
80,000 men. In the British Army the reduction of morbidity 


TYPHUS FEVER 

is estimated at 50 per cent. An excessive dose of infectious 
material may break down the protection resulting from the 
action of the vaccine, yet in such cases the severity of the 
disease will be considerably modified. 

In the army 500 million, 1 billion, and 10 billion bacteria 
are given usually on three successive Saturdays by means of 
a subcutaneous injection near the insertion of the deltoid 
muscle. Occasionally a slight local inflammation with a gen¬ 
eral feeling of malaise develops which disappears within 
twenty-four to forty-eight hours. Consequently it is cus¬ 
tomary to give the vaccine in the afternoon so that any 
reaction which may develop will occur while the individual 
is in bed. The degree of immunity decreases after two and 
a half years. It is advisable, however, in cases of constant 
strain and exposure to revaccinate each year. 

TYPHUS FEVER 

Typhus fever has been known from the beginning of his¬ 
tory as camp, jail, or hospital fever. It was one of the 

plagues of the Middle Ages which, accompaning great wars, 
devastated Europe many times. The most notable epidemic 
of recent times occurred in Serbia in 1915, after the retreat 
of the Austrian army in December, 1914. 

Typhus fever is an acute infectious disease, transmitted 
by infected lice. The period of incubation is from one to 
two weeks, the onset sudden, being marked by severe head¬ 
ache and chills, often on successive days, and a quickly 
rising temperature. The chief diagnostic symptom is a 
mulberry-colored rash which appears about the fifth day on 
the chest, abdomen and back. The rash spreads rapidly 

over the entire body, in severe cases, including the face. 
The rash does not fade upon pressure; the skin is faintly 
flushed so that the body has a uniform dusky purple ap¬ 

pearance. 

In addition to the headache there is usually severe pain 
in the limbs and back. There is always mental confusion 
or dullness and sometimes severe delirium. The fever lasts 
two weeks and ends by lysis, leaving the patient greatly 
prostrated and with little or no change in the mental 
condition. The rate of mortality is very high among pa¬ 
tients who are poorly nourished and who receive little or no 
nursing. 

The first requisite is that the patient should be thoroughly 
deloused, the clothing steam-sterilized, the body carefully 
bathed and some form of petroleum applied to the hairy 
parts. The patient must be kept quiet, free from all out¬ 
side irritation, his delusions humored, and ice applied to his 
head. Water must be given regularly, and in large quan- 



TYPHUS FEVER 


titles. There is usually no gastro-intestinal trouble; and 
food, nourishing and easily digested should be given at 
regular intervals, the patient being aroused for this purpose 
if necessary. There should be, of course, the usual care of 
the bowels. The mouth and teeth require the most unre¬ 
mitting care on account of the tendency to parotid abscesses. 
Similar attention should be given to the skin. Bathing 
seems to have little effect on the temperature but it soothes 
the irritated nerves and helps to keep the skin in good con¬ 
dition. Avoidance of pressure, careful massage towards the 
heart, and systematic bathing are of very great aid in 
averting the abscesses and post-typhus gangrene to which 
severe cases have a tendency. It is sometimes difficult to 
determine the extent of the delirium, therefore, the patient 
needs constant watching to avoid an attempt at suicide. 

The convalescence is a time of anxiety. The patient 
should be kept in bed for ten days after the lysis and 
should be guarded against undue exertion. The mental 
confusion clears up slowly, sometimes lasts many weeks, 
and may escape the notice of the nurse. 

To reiterate: the outcome in typhus depends largely upon 
the nursing care. Adequate nursing in typhus demands: 
thorough delousing, application of cold to the head, the 
avoidance of noise or bustle, humoring the patient, the 
forcing of water, the giving of easily-digested nourishing 
food at regular intervals, exquisite care of the mouth and 
the skin, and constant watchfulness both before and after 
lysis. 

In Serbia, in 1915, Dr. Richard Strong of Harvard 
demonstrated a practical and efficient method of stopping 
epidemics by delousing whole villages and regiments. The 
people entering one end of a sanitary car were bathed while 
their clothes were steam-sterilized. At the other end of 
the car they received their clothes dry and free from 
vermin. By similar methods, the Baltic Red Cross Com¬ 
mission under Dr. Edward Ryan checked an alarming epi¬ 
demic in three weeks in Esthonia and have succeeded in 
preventing subsequent epidemics from entering the Baltic 
States from Russia by maintaining delousing stations on 
the border. 

(See Infectious Diseases, Course of; and Typhoid 

Fever.) 


u 


ULCER OF STOMACH 

See Stomach. 

ULCERS, VARICOSE 

See Skin Diseases. 

UMBILICAL CORD 

See Labor, Management of. 

UREMIA 

This is a toxic condition caused by the presence in the 
ulood of constituents which normally are eliminated by the 
kidneys. These substances when retained in the circula¬ 
tion act deleteriously on the nervous system. 

Physical symptoms. —Headache, nausea, vomiting, dysp¬ 
nea without exertion and often so great that the patient can¬ 
not lie down, arhythmical or Cheyne-Stokes respirations, 
edema of the extremities, twitching of the muscles and con¬ 
vulsions may indicate this condition. In chronic uremia 
the skin is very dry and itching and muscular cramps are 
often severe. The urine may be scanty or suppressed, or 
it may be increased, and contains albumin. 

Mental symptoms. —Vision is often blurred and dimin¬ 
ished and hearing is often rendered more acute. The 
patient may be confused, have illusions and hallucinations 
of hearing and sight, changeable delusions, and be anxious 
and depressed. Consciousness may become clouded and 
restlessness quite marked, and a low muttering delirium may 
follow, or the patient may become stuporous, pass into coma 
and die. 

See Urine, Suppression of. 

URETHANE (ETHYL CARBAMATE) 

Urethane or ethyl carbamate is a colorless, crystalline 
powder with a salty taste. It produces sleep in about 15 
to 20 minutes, the sleep lasting for about 6 to 8 hours. Its 
effects are similar to those of paraldehyde, but it is not 
as reliable. It also increases the secretion of urine. 


URINE 


It does not upset the stomach, however, and because it is 
readily dissolved, it may be given hypodermically. Dose, 
15 to 60 grains. 


URINE 

A nurse should note, particularly, the amount of urine 
voided in twenty-four hours, the amount of each voiding, 
whether voidings are frequent or not, whether any pain, 
discomfort or difficulty is felt in passage, and the color, odor, 
and transparency of the urine. 

The Amount. —The normal amount of urine voided by an 
adult varies from 1000 to 1500 c.c.; by a child (two to 
fourteen years) from 450 to 1500 c.c. A normal adult voids 
from 8 to 10 ounces every 4 to 8 hours. Patients should 
be given the bedpan or urinal at regular hours, usually be¬ 
fore meals and before bedtime. 

The Transparency of Urine. —Normal urine is always clear 
and transparent; on standing nothing but a delicate floating 
cloud is seen in the center. 

Normal urine is acid in reaction and always contains waste 
products in the form of phosphates which are held in solu¬ 
tion by the acid medium. 

The Color of Urine. —The color of urine depends upon 
the amount and kind of pigment, the concentration of the 
urine, the amount and kind of solids, decomposition of the 
solids in it, the presence of abnormal constituents, and the 
action of various drugs. 

The Odor of Urine is said to be characteristic, that is, it is 
like nothing else—the odor of urine about a patient is 
unmistakable. It is due to various volatile, aromatic sub¬ 
stances in it. 

The Collection of Specimens of Urine 

A “Routine” Specimen. —A “routine” specimen is the 
urine passed in one voiding. The whole amount voided may 
be sent for examination, but only four ounces are necessary 
for the tests in a routine examination. Food and exercise 
cause a temporary change in the urine, therefore the best 
time to collect a routine specimen is before breakfast. 

It will be examined for: 

I. Its Reaction, that is, whether it is acid or alkaline. 
Normal urine is acid because., on a mixed or average diet, 
more foods are eaten which yield acid waste products as a 
result of their metabolism than foods which yield alkaline. 
The reaction may vary somewhat, therefore, with the diet. 

II. The Specific Gravity, which depends upon the amount 
of solids in the urine in proportion to the amount of water. 
It is based upon water as a standard—one liter of water at a 


URINE 


certain temperature weighs 1000 grams. Urine is heavier 
than water, because of the solids contained in it. The 
specific gravity of normal urine varies from 1.012 to 1.024 
for an adult, and for a child from 1.008 to 1.020. In dis¬ 
ease it may be as low as 1.002 (showing that the kidneys are 
eliminating a smaller amount of solid waste in proportion 
to the amount of water), or it may be as high as 1.060, 

showing the presence of a large amount of solids. 

III. The Presence of Epithelial Cells and Leucocytes, or 

white blood cells. The kidney tubules, which secrete the 
urine, the ureters and the bladder are lined with epithelial 
cells. These are being constantly worn out and shed in the 
urine (just as the cells of the outer skin), so that there 

will always be a few epithelial cells in the urine. Many 

epithelial cells, however, indicate increased destruction of 

these cells and so indicates disease of the lining of the kid¬ 
ney tubules, the ureters or the bladder. 

IV. The Presence of Albumen. —Albumen is a body pro¬ 
tein which circulates in the blood to supply the cells and 
which forms a necessary constituent of all body cells. 
Normally, in the urine there is a slight or “faint” trace 
of albumen, but too small an amount to be detected by the 
ordinary tests used. 

Albumen in the urine may result from the following con¬ 
ditions : 

1. Acute nephritis, in which the amount of albumen may 
be so great that when the urine is heated it forms a jelly— 
albumen coagulates when heated like the white of egg, which 
is largely albumen. 

2. In febrile conditions, as in scarlet fever and diphtheria, 
etc. Nephritis is one of the dreaded complications to be 
guarded against in these diseases. 

3. Poisoning by ether, bichloride of mercury, carbolic 
acid, lead and cantharides, etc. 

4. An uncompensated or failing heart. 

5. In all severe cases of anemia. 

6. In pregnancy.—Nurses often do routine examinations 
in pre-natal cases to detect such signs. 

V. The Presence of Sugar or Glucose. — Normally there 
is a very faint trace of sugar in the urine. Eating a large 
amount of candy may cause temporarily a marked increase 
of sugar to appear in the urine in a perfectly healthy per¬ 
son. With no such cause, however, the presence of sugar 
indicates that the patient is suffering from a very serious 
disease—diabetes. The presence of sugar in the urine does 
not indicate disease of the kidneys. 

A Twenty-four-Hour Specimen of Urine.— Its Value and 
Importance .— If the routine specimen of urine on examina- 


URINE 


tion shows the oresence of abnormal constituents or if the 
disease from which the patient is suffering makes a more 
thorough examination desirable, all the urine secreted by 
the kidneys during a period of twenty-four hours is meas¬ 
ured, saved, and sent to the laboratory for examination. 
With a specimen of one voiding, it is possible only to make 
a qualitative analysis, that is, to find out what constituents 
or wastes are present, but not a quantitative analysis, that 
is, to find out how much of each waste product is present. 
With a twenty-four-hour specimen—the total amount se¬ 
creted by the kidneys—it is possible to estimate not only 
what wastes the kidneys are eliminating, but the quantity 
of each and so to form an accurate idea of not only how the 
kidneys are working, but of how foods are being utilized in 
the body, and also of other processes of metabolism. Again 
as the urine is altered by diet and exercise, etc., the only way 
to obtain accurate results is to examine the full amount 
voided during the day. 

For instance, a twenty-four-hour specimen is collected 
from 6 a.m. of one morning (or at whatever hour desig¬ 
nated) to 6 a.m., that is, exactly the same hour on the fol¬ 
lowing morning. Now the urine voided at 6 a.m. of the 
first morning has been secreted by the kidneys and collected 
in the bladder during several previous hours—we do not know 
how many—and so must not be included in the twenty-four- 
hour specimen begun at that hour. The patient should void 
and empty the bladder at 6 a.m. (if that is the time for 
beginning), and this urine should be thrown away. If the 
bladder is now empty we know that all the urine voided up 
to and including 6 a.m. of the following morning must have 
been secreted by the kidneys. For the same reason, to make 
our collection complete, we must see that the patient voids, 
and that the bladder is emptied at 6 a.m. of the following 
morning, because the urine contained in the bladder at 
that time has been secreted by the kidneys during the 
period that they are under examination. 

Test for Acetone 

See Diabetes Mellitus. 

Tests for Albumen 

i. Heat and Acetic Acid Test. —Fill a test tube two-thirds 
full of urine. Add about five drops of 2 per cent, acetic 
acid (enough to make the reaction acid), and boil at the 
top, holding the tube at the bottom and directing the flame 
against the upper portion of fluid. Add a few more drops 
of acid, then examine the tube by transmitted light against 
a black background for a cloud in the top portion as com¬ 
pared with the portion just below it. If the precipitate is 


URINE, RETENTION OF 


flocculent, take the tube in a holder and heat the entire 
contents to boiling and stand the tube in a rack. When 
the precipitate has settled, fifteen minutes or more after¬ 
ward, mark the percentage of albumen according to the 
estimated proportion of the column of urine occupied by 
the sediment. 

2. Coagulation of Albumen by Concentrated Nitric Acid .— 
Pour about 2 c.c. (one-half dram) of nitric acid into a 
test tube. Then an equal volume of urine is allowed to 
flow in slowly so as to form a layer above the heavier acid. 
A white ring at the junction of the fluids indicates the pres¬ 
ence of albumen. 

Test for Blood 

Guaiac Test. —To about 4 c.c. of urine add 1 c.c. of glacial 
acetic acid and 2 c.c. of ether; shake gently; pour off the 
ether, and add a few drops of freshly prepared guaiac 
tincture and 1 c.c. of hydrogen peroxide. Never use a 
test tube with yellow copper oxide on its walls resulting from 
Fehling’s or Benedict’s sugar test. A blue color indicates 
the presence of blood. 

Test for Diacetic Acid 

See Diabetes Mellitus. 

Test for Indican 

Mix equal quantities of urine and fresh hydrochloric 
acid and add drop by drop fresh concentrated solution of 
chloride of lime (5 to 1000). Indican is indicated by the 
appearance of a blue color. 

Tests for Sugar 

See Diabetes Mellitus. 

URINE, RETENTION OF 

Retention of urine or failure to void urine may be due 
to: (1) dulling of the senses so that there is no desire to 
void, (2) nervous contraction of the urethra, and (3) some 
obstruction in the urethra or in the neck of the bladder. 

In some cases the bladder may become so fully distended 
that the retention of urine may be accompanied by more or 
less constant voiding of small amounts of urine. 

After operation, occasionally, a patient is unable to void 
urine voluntarily with the result that the urine collects in 
the bladder, the organ becoming dilated beyond its usual 
capacity. Urinary retention is more prone to occur after 
operations about the rectum, the vagina, the cervix, and the 
bladder itself than after operations involving the upper ab¬ 
domen. As a rule, no patient should be allowed to go more 
than twelve to twenty hours without voiding. However, 


URINE, SUPPRESSION OF 

every effort should be made to have the patient void volun¬ 
tarily, because all functions are better performed by nature 
than if mechanically interfered with. 

Treatment. —The treatment of urinary retention is cathe¬ 
terization. A catheterization is a surgical procedure. A 
surgical procedure in clean cases is an aseptic one, and every 
bladder which becomes infected after the introduction of 
the catheter is a horrible reflection upon the individual who 
has done the catheterization. This procedure should be done 
with a good light. The urethral orifice is carefully exposed. 
The catheter, be it rubber, metal, or glass, should be lubri¬ 
cated with a sterile oil, either olive oil or K. Y. While 
catheterization every eight hours is a routine in some 
hospitals after perinorrhaphy, it should be remembered that 
a patient may develop a “catheter habit” because the act ot 
micturition or urination causes slight pain, and catheteriza¬ 
tion affords instant relief without pain. These cases should 
be treated firmly but gently and various expedients should 
be tried to induce voluntary micturition. The drinking of 
large quantities of water, the sound of running water from 
turning on a water faucet within hearing distance of the 
patient, or pouring warm water over the vulva may do much 
to encourage voluntary micturition. 

Catheterization must be done by a nurse with a surgical 
conscience. 

See Catheterization. 

URINE, SUPPRESSION OF 

Suppression of urine is the failure of the kidneys to 
secrete urine. It is usually due to extreme congestion of 
the kidneys, as in acute nephritis. It also follows some of 
the more extensive major operations, especially those upon 
the kidneys or prostate gland. 

Treatment. —The prognosis in all these cases is poor. 
The same methods used by medical men in combating uremia 
resulting from diseased kidneys are used by the surgeon. 
If the kidneys are incapable of physiologically performing 
their function of elimination, then, for the time being, other 
organs must take over that function. There are many 
adjuvants—the sweat glands of the skin, and the intestinal 
canal are invaluable aids. The reflex stimulation of the kid¬ 
neys by counter-irritants, the forcing of fluids so as to dilute 
the poison in the blood, the actual removal of some blood 
with its poisons (phlebotomy), and, finally, operation upon the 
kidney itself, all help in this very serious complication. 

The skin may be used to further aid excretion. If the 
patient will stand it, hot packs should be employed. The 
purpose of a hot pack is to cause perspiration, and inasmuch 


URINE, SUPPRESSION OF 


as urea is one of the chief elements of sweat, a partial 
strain is taken away from the kidneys. Very often this 
procedure alone will be sufficient to stimulate the kidneys to 
excrete urine. Hot packs should he repeated at intervals of 
four to six hours. While the treatment is being admin¬ 
istered, the condition of the patient must be carefully 
watched, for the packing often results in weakness and 
prostration. The other danger of giving a pack to a 
surgical patient is that the body must be carefully dried 
after the treatment in order to prevent post-operative pneu¬ 
monia. In addition, great care should always be taken 
that the skin which has already been made sensitive through 
the application of the ante-operative painting of iodine 
should not be burned, and further avenues of infection 
opened through denuded skin. 

The use of the intestinal tract as an avenue of elimination 
may be further stimulated by employment of colon irriga¬ 
tions. The colon irrigations not only carry off large amounts 
of toxins, but they are a means of supplying water to the 
tissues. 

The kidneys may be stimulated teflexly by counter-irri¬ 
tants applied to the skin of the lumbar region. This may 
be accomplished by the use of flaxseed poultices applied at 
two-hour intervals, or by hot water bottles. Some surgeons 
employ drugs in order to stimulate the kidneys directly, by 
:he use of such substances as theobromine because of its 
direct diuretic action. Five to eight grains are given three 
times a day for the space of three days and then the drug 
is stopped. There is no doubt that this drug is excellent 
in stimulating the kidneys and certainly surpasses caffeine 
in its action. The disadvantage is that it may cause a 
certain amount of nervousness and insomnia. 

Forcing fluids either by protoclysis or hypodermoclysis 
will cause enough fluid to be absorbed to dilute the blood, 
thus resulting in a diminution in the degree of toxemia. 
This simple method not only relieves the patient of an im¬ 
pending uremia, but the kidneys are stimulated by the added 
amount of fluid. 

In cases of high blood pressure with a high blood urea, 
the actual removal of part of the blood volume will do 
much to reduce the nitrogen content of the blood, if only 
for a short period of time. This is done by a phlebotomy, 
or inserting a cannula in a vein in the arm, and permitting 
the patient to be bled of 250 to 700 c.c. of blood. The 
amount withdrawn should depend upon the constitution and 
physique of the patient. Quite often after this procedure, 
250 to 500 c.c. of normal saline are introduced intravenously, 
resulting in further dilution of the toxins. 


UTERUS 


If, in spite of all these procedures, there is no urine ex¬ 
creted, a rather heroic operative procedure may be resorted 
to, that of decapsulating the kidneys. This consists of 
the excision of the capsule from the kidney so that with 
this restraint removed, the organ may be able to work more 
efficiently by establishing new vascular relationships with 
the surrounding tissues, thereby obtaining better nourish¬ 
ment for itself. 


UROPHEN 

See Theobromine. 

UROTROPIN 

See Hexamethylenamine. 

UTERUS 

The uterus is a muscular, pear-shaped organ situated in 
the pelvic cavity between the bladder and the rectum. Its 
normal position is that of anteversion. The part of the 
uterus which projects into the cavity of the vagina is known 
as the cervix. The uterus is lined with mucous membrane; 
and entering the fundus or body of the uterus are the 
openings of the Fallopian tubes. The uterus may be the 
seat of acute inflammations, mal-positions, or new growths, 
either benign or malignant. 

Inflammations of the Uterus 

The mucous membrane of the cervix of the uterus may 
become acutely inflamed due to a variety of causes, espe¬ 
cially from an infection by the gonococcus. This condition 
is known as endocervicitis, and if the inflammation extends 
further and attacks the mucous lining of the uterus, the 
process is known as endometritis. The treatment of this 
condition may be either medical or surgical. 

Treatment of Acute Inflammatory Conditions. —In the 
acute infections, especially those due to a gonorrhea in 
which there is an associated urethritis (inflammation of the 
urethra) and a purulent vaginal discharge, it is of the 
greatest importance to warn the patient of the severe in¬ 
fectiousness of the disease, and the dire results which fol¬ 
low, if it is willfully neglected. It is imperative that the 
hands be kept away from the eyes, because a gonorrheal in¬ 
fection of the organs of sight may cause total and permanent 
blindness. 

The patient should be placed in bed, given a bland non¬ 
irritating diet without condiments or spices, and all alcoholic 
beverages absolutely forbidden. Fluids should be forced to 
the utmost, and the attending nurse should give copious 
vaginal douches every four hours with any silver prepara- 


UTERUS 


tion, either protargol or argyrol in dilutions of i: 10,000. 
In more chronic stages, these may be followed by silver 
nitrate irrigations. 

Cervix. —The cervix, as a rule, is treated by the surgeon 
by direct applications of 10 to 20 per cent, silver nitrate, 
iodine, or 20 per cent, argyrol. The patient is appro¬ 
priately draped, placed in the lithotomy position, a bivalve 
speculum is introduced, and the applications made directly 
to the cervix. However, in all these treatments, while the 
cervix itself may be benefited, it is difficult to reach the 
endometrium or lining mucous membrane of the uterus, and 
very often more radical surgical procedures have to be re¬ 
sorted to. 

Operative Treatment. —One of the most common proce¬ 
dures is the operation known as dilatation of the cervix and 
curettage of the uterus. The purpose of the dilatation is 
to insure sufficient stretching of the cervical canal, so that 
instruments may be freely passed into the uterus, and sec¬ 
ondly to insure drainage of the uterine cavity. The object of 
the curettage is to scrape away the diseased mucous mem¬ 
brane of the uterus so that a new and healthy lining will re¬ 
place the diseased part. While this operation is done for 
chronic inflammation, it is also performed for the retained 
membranes of pregnancy, and for incomplete abortions. It is 
also a diagnostic measure, for in doubtful cases of cancer 
of the uterus, the curettings may be examined for micro¬ 
scopic evidences of malignancy. 

There are cases in which there is a definite stenosis, or 
narrowing of the cervix, resulting in very painful menstrua¬ 
tion (dysmenorrhea) and often in sterility. In order to 
insure a permanent opening of the cervical canal, after 
operative dilatation, a stem-pessary of either glass or rubber 
is often sewed in the cervical canal, and permitted to re¬ 
main in place until the appearance of the next period. 
While the stem-pessary is within the cervix, a daily douche 
of disinfectant variety should be administered, as the me¬ 
chanical presence of the foreign body generates a certain 
amount of disagreeable discharge. 

When the cervix is badly torn, the laceration may become 
a source of irritation. A plastic repair is often done; the 
operation being known as trachelorrhaphy. When the tears 
are multiple it may be necessary to amputate the cervix 
partially or completely. 

Uterus, Malpositions of 

While the normal position is that of anteversion, the 
uterus may occupy a backward position. This is spoken of 
as retroversion. Naturally there are many women who 


UTERUS 


suffer from retroversion without symptoms, but if backache 
and other reflex symptoms are severe, the uterus must be 
replaced. The replacement will be dependent upon the 
movability of the uterus. The uterus may be replaced 

sometimes by manual manipulations by the surgeon with 
the patient in the knee-chest position. Should the procedure 
prove too painful, because of inflammatory products binding 
the uterus to other structures, hot vaginal douches may be 
ordered twice daily, after which the patient is instructed 

to assume the knee-chest position for periods of from five 

to ten minutes, night and morning. This often diminishes 
the inflammation to such a degree that manipulations on the 
part of the doctor are less painful and more successful. 
After the uterus has been replaced it may be held in position 
by pessaries. These are appliances, usually of hard rubber, 
of various forms, which are introduced into the vagina with 
the object of exerting pressure so as to hold the uterus 
in place. Pessaries must never be sterilized by boiling be¬ 
cause, if they are made of rubber, boiling alters their shape. 
If the uterus cannot be brought back by these measures, 

operative procedures must be resorted to. 

Operations for Retroversion. —The purpose of all operative 
procedure is to bring the uterus forward and upward to its 
normal anatomical position and to hold it securely there. In 
the majority of operations this is accomplished by shortening 
the round ligaments. The operation may be performed 
through the inguinal canals, through the abdomen, and 
through the vagina. 

The inguinal canal route :—As the round ligaments help to 
maintain the normal position of anteversion, they may be 
isolated in the inguinal canal, drawn out and sufficiently 

shortened so as to exert tension, and thus mechanically pull 

the uterus forward into place. 

The abdominal route :—The uterus is lifted from its retro- 
verted position and the fundus is sutured to the anterior 

abdominal wall directly (ventral fixation). Or the round 

ligaments are sutured to the recti muscles (the so-called 
Gilliam operation of ventral suspension). 

The vaginal route :—The patient is placed in a lithotomy 
position, and the operation done through the vagina. The 
uterus is brought forward by suturing either to the anterior 
vaginal wall, or the lower part of the bladder, or it is 
pulled into place by shortening the round ligaments. 

Uterus, Prolapse of 

This condition is often called “falling of the womb.” 
Prolapse of the uterus is divided into three degrees. The 
first degree is that in which there is a relaxation of the pelvic 


UTERUS 


floor with a protrusion of the vaginal walls; in the second 
degree, the cervix is found at the vulva; and in the third 
degree there is a mass of the uterus protruding from the 
vagina and lying between the thighs. 

Treatment of Prolapse. —The palliative measures are the 
use of pessaries and tampons. A large circular rubber ring 
in the vagina is often very efficacious in maintaining the 
uterus in position. It is highly important that these pes¬ 
saries be removed at least once a month and cleaned, and 
at the same time the vaginal canal be inspected to determine 
whether any irritation is present. 

The curative measure is operation. The uterus is brought 
forward and upward by a ventral fixation and a perineor¬ 
rhaphy gives support below. In some cases it is often ad¬ 
visable to remove the uterus (hysterectomy). 

Uterus, Sub involution of 

See Subinvolution of Uterus. 

Uterus, Tumors of 

The uterus may be the seat of benign and malignant 
growths. The most common benign tumor is a fibroid. 
These may cause bleeding, vaginal discharge, pain, and quite 
often a mass may be felt within the abdomen. However, 
there are many fibroids which never cause symptoms. Fi¬ 
broids are treated by X-ray, radium, and operation. 

Operative Treatment. —If the fibroids are single and do 
not involve the entire uterus, the tumor may be enucleated 
(myomectomy). If the tumors are multiple and involve most 
of the uterus, the entire organ may be removed (hysterec¬ 
tomy). This is an operation designed to remove the uterus. 
It may be performed through the abdomen (supravaginal 
hysterectomy), or through the vagina (vaginal hysterectomy). 

Supravaginal Hysterectomy. —After the patient is anes¬ 
thetized, she is placed in an exaggerated Trendelenburg 
position. The abdomen is opened by a median incision and 
the intestines are carefully padded off with warm, moist 
saline pads. The fundus of the uterus is seized with a 
vulsellum. The broad ligaments on each side are clamped, 
and, if possible, one of the ovaries is left. The uterovesical 
fold of the peritoneum is incised and dissected toward the 
bladder. The uterine arteries are then clamped and the 
uterus is amputated through the cervix. The cervical stump 
is grasped with a second vulsellum, and the cervical canal is 
cauterized with carbolic acid or iodine. The cervix is then 
united in interrupted sutures, and the vessels usually tied 
with plain gut. The round ligaments are sutured to the 
cervical stump and the two layers of the pelvic peritoneum 
approximated. This, of course, leaves a little cervical tissue 


UTERUS 


which may cause a persistent leucorrhea. To avoid this 
the entire cervix may be extirpated. 

When the pelvic operation has been completed, the pa¬ 
tient should be returned to the horizontal position and the 
abdominal wall closed. Occasionally vaginal drainage is re¬ 
quired. This is done before the abdomen is closed by pass¬ 
ing a curved clamp into the vagina and pressing against the 
posterior vaginal wall behind the cervix. The surgeon incises 
this area and introduces a cigarette drain into the clamp. 
When this is withdrawn, the drain is pulled down into the 
vagina. 

There is no special nursing required post-operatively except 
that a careful watch should be kept for hemorrhage. Oc¬ 
casionally, although fortunately rarely, a ligature slips, and 
a uterine artery will start to bleed. This requires imme¬ 
diate surgical interference. Patients, as a rule, are kept in 
bed for about sixteen days. 

Vaginal Hysterectomy. —This is performed through the 
vagina without an abdominal incision. It has no advantage 
over the other except that it does not leave a scar. 

Malignant Diseases of the Uterus.—These may either 
affect the cervix or the body of the uterus. They are usually 
carcinomatous in character. The treatment is either com¬ 
plete hysterectomy, or the application of radium. 

Uterus, Hemorrhage from 

The causes may be (i) inflammation of the uterus, ovaries 
or Fallopian tubes; (2) tumors; (3) foreign bodies; (4) 
displacements; (5) systemic disorders and visceral diseases 
such as diseases of the heart. 

Menorrhagia is a profuse or prolonged menstrual flow. 

Metrorrhagia is loss of blood in the intervals between 
menstruation. Any irregular bleeding from the uterus or 
unusually profuse menstrual flow, particularly after the 
age of thirty-five, should be reported to a surgeon without 
delay. It may possibly be due to carcinoma in which the 
only hope of cure is in an early diagnosis and surgical inter¬ 
ference. If such a condition is brought to the attention of 
a nurse she should advise that person, without alarming her 
unnecessarily, to consult a surgeon. 

A post partum hemorrhage is one occurring after child¬ 
birth or a miscarriage. 

Treatment .—This depends upon the cause. In all cases 
the patient should be put to bed and kept very quiet. The 
buttocks should be elevated and an ice-bag applied to the 
lower abdomen. Ergot rray be given internally. Hot 
vaginal or intra-uterine douches (118 0 to 120° F.) are usually 
given with or without astringents. Vaginal tampons or 


UVA URSI 


Uterine tampons are frequently inserted to check bleeding 
by pressure. In giving douches or in packing the vagina 
or uterus everything must be sterile. An intra-uterine douche 
or packing the uterus are procedures never attempted by 
a nurse except as a last resort when all other measures have 
failed and only when impossible to secure the services of a 
doctor. 


UVA URSI (BEAR BERRY) 

Uva ursi is obtained from the leaves of the Arctostapliylos 
uva ursi, an evergreen shrub growing in northern Europe 
and the United States. Its active principles are the gluco- 
sides, arbutin and methylarbutin. It also contains an in¬ 
active glucoside ericolin, and small quantities of tannic and 
gallic acids. 

Because of the tannic and gallic acids which it contains, 
uva ursi contracts mucous membranes. 

The principal action of uva ursi, however, is to increase 
the flow of urine, by directly increasing the activity of the 
kidney cells. This effect is due to the arbutin. It also 
acts as an antiseptic on the mucous membrane of the ureter, 
bladder and urethra. 

Preparation 

Fluidextract of Uva Ursi; dose 5 to 15 minims. 


V 


VACCINATION 

See Smallpox. 

VACCINE VIRUS 

This is the pus obtained from the pustules of calves 
suffering with cowpox. The pus is obtained under sterile 
precautions and a little glycerin is added as a preservative. 
It is used for vaccination against smallpox. 

The principle of vaccination depends on the fact that an 
individual who has had an attack of cowpox, becomes 
immune against smallpox. Vaccination produces a mild 
attack of cowpox at the site of the application of the virus. 
This makes the patient immune against smallpox. 

VACCINES, BACTERIAL 

Bacterial vaccines are solutions of dead bacteria in nor¬ 
mal salt solution. A l /i per cent, carbolic acid solution is 
usually added as a preservative. 

They are used to immunize patients against infections 
caused by the same kind of organisms as those that are in¬ 
jected. Vaccines are usually given hypodermically or in¬ 
tramuscularly. There are two kinds of vaccines: Autogenous 
vaccines and stock vaccines. 

Autogenous vaccines are solutions of bacteria, obtained 
from the patient who is being treated. 

Stock vaccines are solutions of bacteria obtained from 
other sources. 

The principle upon which the action of vaccines is based, 
is the following: The injection of the dead bacteria into the 
patient, causes the formation, in the serum of the blood, of 
a substance which excites the phagocytic action (destructive 
action) of the white blood corpuscles, so that they take up 
and destroy the bacteria of the blood more readily. 

The substances formed in the serum by the dead bacteria, 
which increase the phagocytic action of the white blood 
corpuscles, are called opsonins. 


VAGINAL IRRIGATION 


Preparations 

Staphylococcus Vaccine, used in the treatment of acne, 
furuncles and other Staphylococcus infections. 

Streptococcus Vaccine, used in treating Streptococcus 
infections. 

Typhoid Vaccine; it is injected into patients to prevent 
them from contracting typhoid fever when they are ex¬ 
posed to that disease (immunizing them against typhoid). 

Gonococcus Vaccine, is used principally in the treatment 
of gonorrheal joints. 

Bacillus Coli Vaccine. 

Pneumococcus Vaccine. 

Coley s Serum; this is a mixture of Bacillus prodigiosus 
and Streptococci, which is used in the treatment of sar¬ 
coma. 

See Serums. 


VAGINAL IRRIGATION 

This procedure consists in injecting into the vaginal canal, 
with little or no force, a solution of the required tempera¬ 
ture. 

Vaginal irrigations are used as a therapeutic measure in 
the following conditions: 

1. Inflammation and congestion of the vagina or pelvic 
viscera. 

2. Leucorrhea. 

3. Hemorrhage from vagina or uterus. 

4. A cleansing irrigation is usually given as a preparation 
for an operation on the reproductive organs or external 
genitals. 

Contraindications:— 

1. Before or during menstruation. 

2. During pregnancy to avoid causing contractions of the 
uterine muscles with the danger of abortion. 

The Purposes for which they are given are: 

1. To cleanse, disinfect or deodorize.—The solution used 
may be plain sterile water, or an antiseptic such as boric 
acid, lysol, carbolic acid, or silver nitrate, etc.; or a deodor¬ 
ant such as potassium permanganate or formalin. The 
temperature varies from 105° to 112° F. 

2. To relieve pain, inflammation and congestion. 

3. To stimulate the circulation and promote the absorption 
of exudates. 

Astringents —alum, acetic or tannic acid—are used for in¬ 
flammation and congestion. 

Normal salt solution is sometimes used as a stimulating 
irrigation. The temperature varies from 118 0 to 120° F. 

4. To check bleeding.—Sterile water, boric acid, or as- 


VAGINAL IRRIGATION 


tringent solutions are used. The temperature varies from 
118° to 125 0 F. 

Method of Procedure. —The articles necessary for the 
treatment are: A douche pan, a douche can with tubing 
and stopcock attached, a douche nozzle, the solution ordered, 
at the required temperature, and provision for draping the 
patient and for drying the parts after the treatment, and a 
basin for the soiled nozzle. For the routine douche it is 
not necessary to have the can and tubing sterile, but they 
must be clean. The douche nozzle, however, must always 
be sterilized by boiling for five minutes. As glass noz¬ 
zles are frequently used care must be taken that they 
do not break or crack. A cracked nozzle must never be 
used. 

These articles are brought to the bedside properly cov¬ 
ered. 

The Position of the Patient. —The patient should lie in the 
dorsal recumbent position with the shoulders low (remove 
at least one pillow) and the hips elevated so that the solu¬ 
tion will bathe the cervix and all parts of the vagina. She 
should also lie perfectly flat in the center of the bed with 
the douche pan properly and comfortably placed so that 
there is no danger of the return flow soiling the bed. The 
pan should not be placed under the patient until the nurse 
is ready to give the treatment. It should be warm and cov¬ 
ered with a pad or pillow for the comfort of the patient. 
The thighs and knees are flexed and the position made as 
comfortable as possible. 

The gown should be neatly turned back to prevent soiling. 
In cool weather a blanket will be necessary to cover the 
chest. 

The Insertion of the Nozzle. —Before inserting the nozzle 
examine it again to see if it is intact. Allow the solution 
to run through the tubing to warm it. Test the solution 
by the back of your hand. Cleanse the parts by allowing 
the solution to run over them. Insert the nozzle gently. In 
inserting it care should be taken to direct it upward and 
backward behind the cervix uteri to the farthest limit of 
the cul-de-sac to avoid the danger of forcing the solution 
or infected material into the uterine cavity. The nozzle is 
provided with holes at the side and not at the end so that 
there is less danger of this taking place. The solution will 
then flow about the neck of the uterus and circulate through 
all parts of the vagina, distending and bathing it. 

The Duration, Force and Temperature. —The irrigation 
should be given slowly so that as far as possible the vaginal 
folds will be distended and the solution reach all parts 
and remain long enough to have a beneficial effect. Little 


VALERIAN 


or no force should be used in order to avoid the danger of 
forcing the solution into the uterine cavity. The can should, 
therefore, not be more than two or three feet above the 
patient. Hot irrigations are usually used because they lessen 
uterine excitability, muscular contractions, and pain. The 
benefit of the douche is due largely to the heat. 

The vagina being insensitive, very hot irrigations may be 
used without injury to the tissues, but it must be remem¬ 
bered that the perineum and external genitals over which 
the solution flows are very sensitive and may easily be 
burned. This may be avoided by applying grease to the 
part so that the water does not come in contact with the 
tissue. 

Precautions in Infectious Conditions. —When the inflam¬ 
mation is due to infection by the gonococcus care must be 
taken to avoid contraction of the infection or of carrying it 
to other patients. The nurse should wear a gown and 
rubber gloves and should be particularly careful to prevent 
any discharge being carried to her eyes. Goggles should be 
worn to prevent the discharge from spurting into the eyes. 
The utensils should be carefully marked, isolated, and used 
only for that patient. As there is usually considerable dis¬ 
charge, a basin with an antiseptic solution and sponges may 
be necessary to cleanse the parts before inserting the noz¬ 
zle. The sponges should be handled with care and placed 
immediately in a paper bag to be disposed of. 

VALERIAN 

Valerian is obtained from the roots and underground stems 
of the Valeriana officinalis,-a European plant. Its active prin¬ 
ciple is a volatile oil which has a very unpleasant odor, 
especially when it is old. It also contains valerianic acid 
and other substances. 

Valerian has no local action. 

When given internally, it produces the following effects: 

(1) It has an unpleasant taste and odor, it checks the 
formation and aids in the expulsion of gas from the stomach 
(carminative action). 

(2) It allays nervousness, and makes the patient calm and 
quiet; probably because of its unpleasant taste and odor. 

(3) It makes the pulse a little faster and stronger. 

(4) It is said to increase the sweat and the urine. 

Preparations 

Fluidextract of Valerian; dose 30 to 60 minims. 

Tincture of Valerian; dose 1 to 3 drams. 

Ammoniated Tincture of Valerian; dose 1 to 3 drams. 


VEGETABLE CATHARTIC PILLS 


VAPOR BATH 

The method of administering the vapor bath is the same 
as that of the hot-air bath except that the patient is sur¬ 
rounded by vapor or moist air instead of dry air, so that, 
if given in bed, extra rubbers will be needed to protect 
the bed. 

Effects of the Vapor Bath. —The effects are the same as 
those attributed to the hot-air bath, but are very much more 
intensified, as shown in the following results: 

1. The body temperature is increased more rapidly, and 
to a greater degree. 

2. The oxidation of protein is greatly increased, therefore 
it is useful in gout, rheumatism, etc., when oxidation of 
protein wastes is incomplete. 

3. The pulse is more rapid, blood-pressure lower and the 
heart quickly tires out. 

4. Respirations are also rapid, but not in proportion to 
the pulse, so that the tissues lack oxygen. 

5. Perspiration is more rapid and profuse. 

The vapor bath is used as a therapeutic measure in the 
treatment of the same conditions as those mentioned under 
the hot-air bath. 

The temperature of the vapor bath varies from 120° to 
130° F. 

The duration of the bath when used as a preparation for 
a cold bath varies from 3 to 5 minutes and when used to 
increase eliminations from 15 to 30 minutes. 

The principles underlying the procedure and the precau¬ 
tions to be observed are the same as in the hot-air bath, but 
as the vapor bath is much more vigorous and exhausting, 
therefore more dangerous, the patient must be watched more 
closely. 


See Testicle. 


VARICOCELE 


VARICOSE ULCERS 

See Skin Diseases. 


VARIOLA 

See Smallpox. 

VARIOLOID 


See Smallpox. 

VEGETABLE CATHARTIC PILLS 

See Cathartic Pills. 


VENEREAL DISEASES 


VENEREAL DISEASES 

Syphilis, Gonorrhea and Chancroid constitute a group 
known as the venereal diseases, concerning which the gen¬ 
eral public is little informed because of a false sentiment 
which has banished them from mention until very recent 
years. 

Syphilis 

Syphilis is a chronic disease, due, like tuberculosis, to a 
germ of comparatively slight virulence, but of great staying 
powers. It does not complete its course in the body rapidly 
like scarlet fever, diphtheria or even typhoid fever, but 
remains more or less active for many years. 

The syphilis germ is probably of the animal rather than 
the vegetable kingdom, a protozoon rather than a bac¬ 
terium. It usually enters the body through a scratch or 
abrasion of the skin or a mucous membrane. Notwithstanding 
that it is so constantly spoken of as a venereal disease, 
very many cases are contracted from ordinary contact— 
use of the same towels, pipes, drinking glass, etc., although, 
of course, the majority are venereal. But even the ven¬ 
ereal cases are by no means necessarily illicit; at least half 
of the total cases being innocently acquired, as from hus¬ 
band to wife or vice versa. It is possible, though usually 
held improbable, that mouth-spray and hands may enter into 
its transfer exactly as in scarlet fever or diphtheria. Cer¬ 
tainly this is possible in those cases where the infecting 
individual is afflicted with open sores in mouth or nose. 

The incubation period of the initial sore or chancre is 

variable, roughly, three weeks. It appears as a firm, hard 
pimple, enlarges, and typically disappears again, leaving 

perhaps a scar, often not. Usually nothing further happens 
for several weeks, when a number of symptoms related to 
the surface of the body appear, sores in the mouth and on 
the tongue, sore throat, rashes of various kinds, falling 

out of the hair, together with bone-pains, anemia, general 
debility. These tend to disappear in time, especially under 
treatment, although in neglected cases very terrible con¬ 
ditions may arise. 

Two or three years or more later, the third stage, that 
of tumors, developing under the skin or internally, appears. 
Often, especially in treated cases, this stage is delayed for 
almost a lifetime, appearing late and ending miserably an 
otherwise healthy and successful life. 

A fourth development is the parasyphilitic stage in which, 
without actual tumors, a general poisoning of the nervous 
system occurs, giving rise to many of our aged crippled, 
both in body and in mind. 


VENEREAL DISEASES 


It is transmissible to the child in utero, i.e., before 
it is born. Fortunately many syphilitic parents lose their 
children by premature birth or in the early months after 
birth. 

The first and second stages of syphilis are infectious. 
Immunity seems to exist to second infections so long as 
the first infection is present (tolerance). On complete cure, 
the disease may be contracted a second time. 

Gonorrhea 

Gonorrhea has often been described as a “cold” affect¬ 
ing the mucous membranes of the genital tract. Unfortu¬ 
nately, while this description is not a bad one, the implica¬ 
tion that the disease is therefore mild and negligible is 
lamentably false, for the “cold” is usually accompanied by 
severe symptoms, and complete recovery is rare. As real 
“head colds” present carriers who, not being immune, in¬ 
fect others, and themselves constantly suffer from recur¬ 
rences, so also does gonorrhea, but much more frequently. 
Again, as a “head cold” often extends along the passages 
connected with the site of the initial trouble, i.e., along the 
Eustachian tube to the ear, by other openings to the sinuses, 
or to the pharynx and windpipe or even the lungs, so in gon¬ 
orrhea extension to connected parts occurs, with resulting 
complications of many descriptions. 

From fifty to eighty per cent, of all major operations on 
women are traceable to gonorrheal infections, while an 
immense number of cases of stricture, prostatitis, cystitis, 
etc., in men are due to the same organism. Blindness in 
children, the result of infection of the eyes in the very 
process of birth, is far too common, although the com¬ 
parative rarity of this disease of the eyes in adults, despite 
the prevalence of gonorrhea in its ordinary forms, points 
to a high average of insusceptibility of the eyes, for transfer 
of gonorrheal infection to the eyes by the hands must 
be very common, yet gonorrheal ophthalmia is relatively 
rare. 

Gonorrhea has an incubation period of from three days 
to two weeks, and is probably infectious during this period. 
The prodromal period is short and indefinite, terminating 
with the appearance of the discharge. The acute symptoms, 
pain, fever, etc., last a week or more and in uncomplicated 
'lases tend to lessen, the discharge becoming chronic. Few 
cases even under the best treatment are completely recovered 
within six weeks; non-infectiousness is of late years con¬ 
sidered a very rare stage, if it is ever reached at all. 

Hereditary syphilis and gonorrhea, in the true sense of 
heredity, are very uncommon. In the sense that they are 


VERATRINE 


contracted by the child at birth, or before birth from the 
parents, hereditary syphilis is very common. 

Chancroid 

Soft chancre or chancroid is a comparatively mild affec¬ 
tion, usually appearing as a ragged, shallow ulcer, highly 
infectious but easily controlled by antiseptic treatment. 
Its chief interest lies in the fact that the syphilis chancre 
is often present with it and escapes recognition because 
obscured by the much worse looking and more extensive 
chancroid. 

The modern therapeutic treatment of syphilis has two 
advantages: one, that it controls the disease in the patient 
with remarkable power; the second that it quite rapidly 
makes the patient non-infectious by killing the germ in, or 
driving it from, the surface lesions. Confusion of mind 
sometimes leads the patient who is thus rendered non- 
infectious to believe that he is cured—an unfortunate mis¬ 
take in all cases. 

The control of the venereal diseases consists in finding 
and isolating the infected persons. It is true that these 
exist in enormous numbers and carriers not actively sick are, 
in gonorrhea especially, very common. 

Persons in infectious stages of either disease should not 
be allowed contact with normal individuals, but it is far 
more important to isolate syphilis than gonorrhea, because 
carriers of the latter, apart from the sexual act, or the care 
of children, are not extremely dangerous to others. 

VERATRINE 

Veratrine is a mixture of all the alkaloids found in Vera- 
trum sabadilla, or Asagraea officinalis, a Mexican plant 
known as cevadilla. The most important of these alkaloids 
are veratrine and cevadine, which are also found in veratrum 
viride. 

It produces the same effects as veratrum. 

It is used principally to relieve pain in neuralgia, rheu¬ 
matism, etc. 

Preparations 

Veratrine Ointment contains 4 per cent, of veratrine. 

Oleate of Veratrine contains 2 per cent, of veratrine. 

See Veratrum. 

VERATRUM (AMERICAN HELLEBORE) 

Veratrum is obtained from the root and underground 
stems of the Veratrum viride, cr green hellebore, a plant 
which grows in swampy places ?.n the northern part of the 
United States. 


VERONAL 


The active principles of veratrum are the alkaloids, ceva- 
dine and veratrine. These alkaloids are very closely related 
to aconitine chemically, and they produce very similar 
effects. 

The following are the principal effects of veratrum. They 
resemble those of aconite but they differ in several instances: 

1. Locally veratrum is very irritating to the skin and 
mucous membrane but is soon followed by a local soothing 
effect. It causes profuse sneezing and coughing when in- 

'*► haled. 

2. It frequently causes nausea and vomiting. 

3. It makes the heart beat slower and weaker, by in¬ 
creasing the impulses sent to it through the vagus nerves, 
thus causing a slow, soft pulse. 

4. It lowers the blood pressure. 

5. It slightly increases the contraction of muscles but it 
markedly prolongs the period of relaxation. This is a very 
characteristic effect of veratrum and is often spoken of as 
“veratrine effect.” 

Veratrum is used principally to lower blood pressure in 
eclampsia, a condition of poisoning occurring in pregnancy. 

Preparations 

Fluidextract of Veratrum; dose 1 to 5 minims. 

Tincture of Veratrum; dose 5 to 15 minims. 

See Aconite. 


VERMICIDES 

See Anthelmintics. 

VERMIFUGES 

See Anthelmintics. 

VEROFORM 

Veroform is a liquid obtained by dissolving formaldehyde 
gas in a solution of soap. It contains 6 to 20 per cent, 
formaldehyde gas and is used as a surgical antiseptic. 

VERONAL 

Veronal, or diethyl barbituric acid, is a white crystalline 
powder, which has a slightly bitter taste. About fifteen 
minutes to half an hour after an average dose of veronal is 
given, the patient usually falls asleep. The sleep resembles 
the normal sleep, and lasts for five to six hours. On awak¬ 
ening, the patient often complains of headache and dizziness. 
Occasionally, some patients have peculiar vivid dreams during 
the sleep. The pulse and breathing are not usually affected 
by veronal. It is a comparatively safe drug in small doses; 
but poisonous symptoms (coma, slow pulse and shallow 


VESCETTES 


breathing) have occasionally followed its indiscriminate use, 
especially in old people. Veronal is given in hot milk, 15 
to 30 minutes before bedtime. Dose 5 to 15 grains. 

VESCETTES 

Vescettes are effervescent salts compressed into a tablet. 


VIBURNUM OPULUS 

Viburnum opulus, or cramp root, is obtained from the, 
bark of the Viburnum opulus, a small American tree. 

It acts like viburnum prunifolium, but is less soothing 
to the uterus and is said to relieve colic and cramp-like 
pains, more than viburnum prunifolium does. 

Preparation 

Fluidextract of Viburnum Opulus; dose y 2 to 4 drams. 


VIBURNUM PRUNIFOLIUM 

Viburnum is obtained from the root of the Viburnum 
prunifolium or black haw, a small American plant. 

It lessens the contractions of involuntary muscles, espe¬ 
cially the muscles of the uterus. It soothes uterine con¬ 
tractions, and is said to check colic and cramps. 

It is used principally to relieve painful or excessive 
menstruation, and to relieve the pains of ovarian disease. 

Preparation 

Fluidextract of Viburnum Prunifolium; dose J 4 to 4 
drams. 

VIENNA PASTE 

See Alkalines. 


VINCENT’S ANGINA 


See Pharynx. 

VINEGAR 

See Acetic Acid, Dilute. 


VINEGARS 

Vinegars are medicinal substances dissolved in a weak 
solution of acetic acid, or vinegar. 


VIT AMINES 

See Food. 

VITRIOL 

See Sulphuric Acid. 

VOCAL CORDS 

See Larynx. 

VOMITING 

See Stomach; Pernicious Vomiting (Post-Operative). 


w 


WARBURG’S TINCTURE 

See Quinine. 


WASSERMANN REACTION 

The diagnosis of the syphilitic diseases of the central 
nervous system has been much simplified by the Wassermann 
blood test and the analysis of the spinal fluid. The Wasser¬ 
mann reaction, or test, is a complex biological reaction which 
depends on the fact that the blood of men and animals 
acquires the power to destroy certain substances, bacteria, 
etc., when these are present in the body for some time or 
when they are introduced into it repeatedly in small quan¬ 
tities. This test confirms the diagnosis when the symptoms 
point to syphilis, and helps to make positive the diagnosis 
in doubtful cases. To carry out this test the following sub¬ 
stances are required: The blood serum of the patient which 
has been heated and cooled, the blood serum from a normal 
guinea pig, a watery extract of syphilitic tissue which con¬ 
tains the microorganisms in large numbers, a definite number 
of red blood corpuscles from a normal sheep and the blood 
serum from a rabbit into whose body red blood corpuscles 
from a sheep have been injected at repeated intervals, which 
has been heated and later cooled. The various substances 
are placed in a test tube in definite quantities and order 
and the mixture is placed in an incubator for definite periods. 
When a patient has had syphilis and there are substances in 
his blood which tend to destroy the syphilitic organism, 
treponema pallidum, no change takes place in the opaque 
appearance of this red mixture of blood serum, corpuscles, 
etc. This is said to be a strongly positive reaction, or in 
the terms of the laboratory it is “four plus,” and indicates 
that the disease is not cured. If, however, the patient 
never has had syphilis, the mixture loses its opaque appear¬ 
ance and becomes clear, and the reaction is said to be neg¬ 
ative. When the change is slight, or when the mixture 


WEIGHTS AND MEASURES 


becomes only partly clear, or almost clear with only slight 
cloudiness, it is said to be three plus, two plus or one plus. 

This test is also made with the spinal fluid, for in tabes 
dorsalis and the cerebral forms of syphilis the spinal fluid 
often gives a positive reaction when the blood does not. 

The microscopic examination of the spinal fluid usually 
shows an increase in the number of white blood corpuscles. 

The blood for the Wassermann test is obtained from the 
veins of the arm. The skin is thoroughly cleansed with soap 
and water and dried with alcohol. It is further prepared 
by the application of tincture of iodine. Other preparations 
are to boil the syringe and needles, have ready a sterile test 
tube to receive the blood, a tourniquet to apply to the arm 
and a sterile dressing to apply when the needle is withdrawn. 
WATER, USES OF 

The uses of water in the body are many, and the advantage 
arising from a sufficient amount of this foodstuff in the 
dietary cannot be overestimated. It is no longer considered 
an error in diet to drink a moderate amount of water with 
the meals, so long as it is not used as a substitute for masti¬ 
cation, and as a means of washing the food into the stomach. 
In the diet, both as a beverage and as a part of most of 
the food materials ingested, water serves to moisten the 
tissues; to furnish the fluid medium for all of the secretions 
and excretions of the body; to carry food materials in solu¬ 
tion to all parts of the organism; to stimulate secretory cells 
producing the digestive juices, thereby aiding in the process 
of digestion, absorption and excretion; to promote circula¬ 
tion; to furnish material for free diuresis, thus preventing 
to a great extent the retention of injurious substances by 
the body, which might otherwise take place. 

WEIGHT 

See Height and Weight. 

WEIGHTS AND MEASURES 
The Metric System 

The elementary unit of measurement in the metric system 
is the one for length. This is the meter, which is about one 
ten-millionth part of the distance from the equator to the 
north pole. It is equal to about 39.37 inches and is written 
as 1.0 m. 

Table of Length. —The unit is 1.0, one meter. 

One-tenth of the meter is 0.1, one decimeter. 

One-tenth of the decimeter is 0.01, one centimeter. 

One-tenth of the centimeter is 0.001, one millimeter. 

Table of Volume. —The volume of a substance is the 
amount of space which it occupies. 

A quantity of space one meter long, one meter wide and 


WEIGHTS AND MEASURES 


one meter high, is one cubic meter, which is the unit of 
volume. 

This is divided into a thousand cubic decimeters, each of 
which is again divided into a thousand cubic centimeters 
and this in turn into a thousand cubic millimeters. 

Table of Capacity. —In measuring fluids, we measure the 
quantity of fluid contained in a given space. The space 
which the fluid occupies varies with its character and tem¬ 
perature; thus an oily substance will occupy less space 
than boiling water. We therefore take the space occupied 
by water at 4 0 Centigrade as the standard. 

The unit of capacity is the liter, which is the amount of 
water contained in a volume of one cubic decimeter. 

The liter is divided into deciliters, centiliters and milli¬ 
liters. The deciliter is a tenth, the centiliter a hundredth, 
and the milliliter a thousandth part of the liter. Since the 
liter occupies one cubic decimeter of space, the milliliter 
will occupy one thousandth part of that, and is therefore 
equivalent to the cubic centimeter. 

The new Pharmacopeia has adopted the term mil, the 
abbreviation for milliliter, instead of c.c. (cubic centi¬ 
meter). For example, 50.0 c.c. are now written 50.0 mils, 
0.3 c.c. as 0.3 mil, etc. 

Table of Weight. —Solid substances are usually measured 
by weight. 

The unit for measuring weight is the gramme; which is 
the weight of one cubic centimeter of water at a tempera¬ 
ture of 4 0 Centigrade, written: 

1.0 gm., one gramme. 

One-tenth of the gramme is 0.1 gm., one decigramme. 

One-hundredth of the gramme is 0.01 gm., one centi¬ 
gramme. 

One-thousandth of the gramme is 0.001 gm., one milli¬ 
gramme. 

Since 1.0 (one gramme) is the weight of 1 mill or 1 
cubic centimeter of water, in expressing the quantities of 
fluids, which are measured by capacity, the denomination 
1.0 means one mil or one cubic centimeter, 2.0, two mils 
or two cubic centimeters (2 c.c.), etc. 

Apothecaries’ System 

Table of Weight (Measurement of Solids). —The unit of 
measurement is the grain, which is equal to 0.065 gm. (sixty- 
five milligrammes) in the metric system. The grain is writ¬ 
ten thus: gr. i. 

20 grains = 1 scruple 
3 scruples or 60 grains = 1 dram (5) 

480 grains or 8 drams = 1 ounce (J) 

5760 grains or 12 ounces = 1 pound (lb.) 


WET NURSE 


Table of Capacity (Fluid Measurement).—The unit of 
measurement is the minim, \yhich is equal to 0.065 c.c. It 
is written nr. i. 

60 minims = 1 fluid dram (5) 

8 fluid drams = 1 ounce 

16 ounces = 1 pint (O) 

2 pints = 1 quart (qt.) 

4 quarts or 8 pints = 1 gallon (gal.) 


Table of Equivalents 

Value of Metric Units in Apothecaries’ Units 


One milligramme. 
One centigramme 

Grain 

o.i543 

0.15433 

Dram 

0.00026 

Ounce 

Pound 

0.0026 

0.00032 


One decigramme . 

1.54324 

0.0257 

0.0032 

0.00027 

One gramme. 

15.43236 

0.257 

0.03215 

0.00270 

One kilogramme.. 

15432.3564 

257.206 

32.1508 

2.6792 


Approximate Equivalents of Metric Units 


Weight 


One milligramme 

0.001 

gm. = Hu of a grain 

One centigramme 

O.OI 

gm. = Va of a grain 

One decigramme 

O.I 

gm. = 1 y 2 grains 

One gramme 

1.0 

gm. = 15^4 grains 

(in prescriptions 15 grains) 

One kilogramme 

1000.0 

gm. = 32 ounces or 2% lbs. 


Capacity 

One cubic centimeter, 1.0 c.c. = 15 minims 

One liter, 1000.0 c.c. = 32 oz. or 2 pts. (approx- 

mately one qt.) 


Approximate Equivalents of Apothecaries’ Units 
Weight 

One grain = 0.065 gm. (65 milligrammes) 
One dram =- 4.0 gm. (4 grammes) 

One ounce= 30.0 gm. (30 grammes) 


One minim 
One dram 
One ounce 
One pint 
One quart 




Capacity 

0.065 c.c. 

4.0 c.c. (4 cubic centimeters) 

30.0 c.c. (30 cubic centimeters) 

500.0 c.c. (500 cubic centimeters) 

000.0 c.c. (one liter) 


WET NURSE 

See Infant Feeding. 


WHISKEY 


See Alcohol. 

WHITE LEG 

See Phlegmasia Alba Dolens. 












WITCH HAZEL 


WHOOPING COUGH 

Nursing Care.—Much attention must be given to keeping 
up nourishment. When vomiting occurs with attacks of 
whooping give nourishment in small amounts frequently. 
If the patient vomits, feed again soon in the hope that this 
will be retained. An abdominal binder may be used to relieve 
strain. 

Patients need plenty of fresh air. If possible have the 
crib or bed on the porch. Keep the patient sufficiently 
warm, as pneumonia is a frequent and often fatal compli¬ 
cation. 

The patient should be isolated from other children; but 
the disease is not thought communicable after six weeks, 
although the patient may whoop for from four to six months. 

WIDAL REACTION 

If the serum of a patient suffering from typhoid fever is 
added to an emulsion of typhoid bacilli, and the mixture 
placed in the incubator for a short period, the bacteria 
which were formerly scattered throughout the fluid will be 
found to have clumped together in small masses at the 
sides of the test tube, and as they gradually fall to the 
bottom the fluid becomes clear. If a hanging drop prep¬ 
aration is made it will be observed that with the addition 
of serum the bacilli move closer together, gradually losing 
their motility, until finally they adhere in clumps. 

Serum may be obtained by pricking the finger or ear lobe 
with a sharp-pointed instrument or needle and allowing the 
blood to pass into a Wright’s capillary tube. Whole blood 
may be used, in which case one or two drops are placed on 
a slide and dried and later brought into solution again by 
the addition of salt solution. 

In typhoid fever a positive agglutination reaction may be 
given as early as the third day of the disease; ordinarily 
it does not appear before the seventh or eighth day. Oc¬ 
casionally the reaction may be absent or occur only during 
convalescence; as a rule it is strongest durmg convalescence, 
remains positive several weeks and then disappears. 

, See Typhoid Fever. 

WINES 

Wines are preparations of drugs dissolved in wine. They 
are made like the tinctures but have a better flavor. 

See Alcohol. 


WITCH HAZEL 


See Hamamelis. 


WINTERGREEN 


WINTERGREEN 

See Salicylic Acid. 

WOOD ALCOHOL 

Wood Alcohol is made by the destructive distillation of 
wood. It is very inflammable, and because it is cheap it is 
used as a solvent for various substances. 

Wood alcohol is not used in medicine but it is of great 
interest because of its poisonous effects. These result from 
the fact that it is frequently substituted by unscrupulous 
manufacturers for ordinary alcohol in the manufacture of 
essences such as soda water flavors, Jamaica ginger, witch 
hazel, bay rum. cologne, etc. Many patent medicines con¬ 
tain wood alcohol. Since the advent of prohibition cases 
of wood alcohol poisoning have greatly increased because 
many beverages are prepared with wood alcohol since it 
is so difficult to obtain ordinary alcohol. 

Wood Alcohol Poisoning 

There are two forms of wood alcohol poisoning: the acute 
poisoning and the chronic poisoning. The acute symptoms 
follow the drinking of intoxicating or other liquors contain¬ 
ing wood alcohol. The chronic symptoms result from the 
continued use of local applications containing wood alcohol. 

Acute Wood Alcohol Poisoning 

Symptoms. —The symptoms are due to the fact that wood 
alcohol is not oxidized in the body as is ordinary alcohol, 
but affects principally the brain and nerves. 

The symptoms begin like an ordinary alcoholic intoxica¬ 
tion with excitement and exhilaration. This is followed by: 
Nausea, vomiting, dizziness,- headache, dilated pupils, and 
delirium. Persistent coma and death may occur within a 
few hours or a few days. The patient may recover from 
the acute symptoms but may go blind just the same from 
destruction of the optic nerve (Optic neuritis). Blindness- 
has resulted from as little as five teaspoonfuls; and death 
has resulted from a half a pint of wood alcohol. 

Treatment. — x. Wash out the stomach. 

2. Pour hot and cold water over the patient alternately. 

3. Give artificial respiration. 

4. Strychnine, caffeine and other stimulants are given. 

Chronic Wood Alcohol Poisoning 

Prolonged use of wood alcohol may cause blindness from 
destruction of the optic nerve (optic nerve atrophy). This 
may occur from its internal use or from external applica¬ 
tions of various toilet preparations. 


WOUNDS 


See Lice. 


WOOD-TICKS 


WORMS 

See Anthelmintics. 


WOUNDS 

Accidental wounds may be incised, stab, punctured, 
lacerated, contused, or poisoned wounds. 

Incised wounds are caused by a sharp, cutting instrument, 
such as a razor, which severs the tissues causing them to 
gape open. 

Stab wounds are caused by a sharp, cutting, pointed in¬ 
strument, such as a dagger or knife. 

Punctured wounds are made by a sharp, narrow, pointed 
instrument, such as a needle, splinter of wood or a nail. A 
rusty nail is more dangerous because being rough it injures 
the tissues more and also holds more dirt and bacteria. 
Gunshot wounds are also punctured wounds. 

A contused wound is made by a blunt instrument. The 
skin is ruptured, crushed or split and the tissues around 
are bruised. 

A lacerated zvound is one in which the tissues are torn 
apart—the edges are roughened and jagged and there is 
more or less contusion around it. Examples are, the bite 
of an animal, torn knuckles caused by striking the mouth 
and teeth, a hook drawn through the tissues, and wounds 
caused by machinery. 

Poisoned wounds may be caused by the bites of poisonous 
snakes or spiders, a “mad” dog, and insect bites and stings. 

Dangerous Effects of Accidental Wounds. — (i) Deeper 
structure such as tendons, muscles, nerves and large blood 
vessels may be injured, especially in incised and stab 
wounds. 

2. Hemorrhage is apt to be severe especially in incised 
and stab wounds. In punctured wounds the hemorrhage 
may be slight because the blood vessels are pushed ahead or 
aside. In a lacerated wound also, the blood clots more easily 
in the roughened irregular tissue and torn vessels tend to 
contract so are not so apt to bleed. 

3. Shock may be severe, especially in wounds to the chest, 
abdomen, skull or large blood vessels. 

4. Infection by pyogenic organisms or the tetanus bacillus 
may occur from dirt, clothing, powder, or other foreign 
body carried into the wound. (Slight wounds, even a pin¬ 
prick, are often the most serious because so apt to be 
neglected.) Foreign bodies always help bacteria to gain 
a foothold. Infection is more apt to occur in the old or 
in otherwise weakened individuals. 


WYETH’S PINS 


Treatment of Wounds. —The first-aid treatment is to stop 
bleeding, relieve or prevent shock, keep the wound clean and 
absolutely at rest. If available, iodine and a sterile dressing 
should be applied and, if severe, a splint or sling to keep 
the part at rest. Expert treatment by a surgeon should be 
obtained as soon as possible, especially in wounds about the 
face to avoid deformity from scar formation. 

See Dakin’s Solution. 

WYETH’S PINS 


See Amputations. 


. - 




X 

XEROFORM 

Xeroform is a bismuth preparation, and is used principally 
as an antiseptic dressing in ulcers of the leg, eczema, and 
as an intestinal antiseptic. Dose 15 to 45 grains, 


Y 


YELLOW FEVER 

See Mosquitoes. 

YELLOW WASH 

See Mercury. 

YOUNG’S RULE FOR DOSAGE 

See Dosage. 


z 


ZEA (CORNSILK) 

Zea is obtained from the silky threads of the Zea mays, 
Indian corn or maize. 

Zea increases the flow of urine and acts as an antiseptic 
on the mucous membranes of the ureter, bladder and urethra. 

Preparation 

Fluidextract of Zea; dose i to 2 drams. 

ZINC 

Zinc is a metal which forms salts, many of which are used 
in medicine. 

Chronic Zinc Poisoning 

Chronic zinc poisoning occasionally occurs among workers 
who handle zinc. It causes symptoms like those of lead 
poisoning. 

Uses 

Zinc sulphate is used to produce vomiting. The other 

zinc salts are used as astringents in various skin diseases 
and ulcers. 

Preparations 

Zinc Sulphate (as an emetic); dose 5 to 30 grains. 

It is used as an eye wash in *4 to per cent, solutions 
and as an injection in gonorrhea in 1 to 4 per cent, solu¬ 
tions. 

Zinc Oxide; dose 2 to 8 grains. 

Zinc Oxide Ointment. 

This contains 1 part of zinc oxide to 4 parts of ben> 
zoinated lard. 

Precipitated Zinc Carbonate; dose 2 to 8 grains. 

Zinc Stearate. 

This is used as a dusting powder on ulcers, and on various 
skin diseases. 

Zinc Acetate. 

This is used for injections and douches, in gonorrhea. 

Zinc Chloride. 

This is a white powder which is moulded into pencils. 


ZINGIBER 


It absorbs moisture from the air. It is used to destroy 
tissues (caustic action). It is an ingredient of many 
“cancer cures,” and is applied as an ointment to destroy 
the cancerous tissue. 

Solution of Zinc Chloride. 

This contains about 36 per cent, of zinc chloride, and is 
used as a disinfectant for sinks and toilets. 

Burnett’s disinfecting fluid. 

This contains zinc chloride. 

Zinc Iodide; dose 1 to 2 grains. 

It is used locally as a caustic and to increase the growth 
of tissue. 

Zinc Valerate; dose 1 to 2 grains. 

Zinc Bromide; dose 1 to 2 grains. 

This is used to lessen nervousness and the twitchings of 
chorea and epilepsy. 


See Ginger. 


ZINGIBER 


See Matzoon. 


ZOOLAK 


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